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Perimenopause: Navigating the Hormonal Rollercoaster

picture of a woman touching her neck while she is having a hot flash due to perimenopause and wondering how to treat perimenopause naturally
Perimenopause can be managed naturally

Note: This blog post is for informational purposes only and should not be considered a substitute for professional medical advice. Always consult a healthcare provider for personalized guidance on managing perimenopause and related issues.


Perimenopause, often called the “menopausal transition,” is a natural phase in a woman’s life that can span several years. During this time, the body undergoes significant hormonal changes as it prepares for menopause when menstruation ceases completely. These hormonal fluctuations can lead to a wide range of physical and emotional symptoms, making perimenopause a challenging journey for many women. In this blog post, we will delve into the science behind perimenopause, its symptoms, and strategies for navigating the hormonal rollercoaster.

Understanding Perimenopause

What is Perimenopause?

Perimenopause is the transitional phase that precedes menopause. It typically begins in a woman’s 40s, although it can start earlier for some and later for others. This phase lasts an average of four to eight years, but the duration can vary significantly between individuals.

During perimenopause, the ovaries gradually produce fewer hormones, particularly estrogen and progesterone. These hormonal changes lead to irregular menstrual cycles and physical and emotional symptoms. Perimenopause ends when a woman has not had a period for 12 consecutive months, at which point she has reached menopause.

Hormonal Changes in Perimenopause

To understand perimenopause better, it’s crucial to examine the hormonal changes that occur during this phase:

  1. Estrogen Levels: Estrogen is a key hormone that regulates the menstrual cycle and various bodily functions. During perimenopause, estrogen levels fluctuate wildly, leading to irregular periods and symptoms like depression, hot flashes and vaginal dryness.
  2. Progesterone Levels: Progesterone, another essential female hormone, also decreases during perimenopause. This hormonal shift can result in mood swings, sleep disturbances, and changes in menstrual flow.
  3. Follicle-Stimulating Hormone (FSH): FSH is a hormone released by the pituitary gland that stimulates the ovaries to produce estrogen and release eggs. In perimenopause, FSH levels rise as the ovaries become less responsive to its signals, leading to higher levels of FSH in the bloodstream.
  4. Luteinizing Hormone (LH): LH works alongside FSH to regulate the menstrual cycle. Like FSH, LH levels also increase during perimenopause.
  5. Androgens: While often associated with males, androgens like DHEA and testosterone are also present in women. In perimenopause, the balance between estrogen and androgens can shift, potentially causing symptoms such as acne and changes in hair growth.

Symptoms of Perimenopause

The hormonal fluctuations that characterize perimenopause can lead to many symptoms. It’s important to note that not all women will experience every symptom, and their severity can vary greatly. Common perimenopausal symptoms include:

  1. Irregular Periods: Changes in the menstrual cycle are hallmark signs of perimenopause. Periods may become irregular, shorter, longer, heavier, or lighter.
  2. Hot Flashes: Sudden, intense waves of heat, often accompanied by sweating and flushing, can be disruptive. They typically last a few minutes but occur multiple times daily or at night.
  3. Night Sweats: Similar to hot flashes, night sweats cause excessive sweating during sleep and can disrupt sleep patterns.
  4. Vaginal Changes: Reduced estrogen and testosterone levels can lead to vaginal dryness, itching, and discomfort, impacting sexual health and overall quality of life.
  5. Mood Swings: Hormonal fluctuations can affect mood and lead to irritability, anxiety, and depression.
  6. Sleep Disturbances: Many women in perimenopause experience sleep problems, including insomnia and waking up frequently at night.
  7. Weight Gain: Changes in hormone levels can contribute to weight gain, particularly around the abdomen.
  8. Fatigue: Persistent fatigue and a lack of energy are common complaints during perimenopause.
  9. Changes in Libido: Some women may experience decreased sexual desire and arousal.
  10. Cognitive Changes: Memory lapses and difficulty concentrating can occur, often called “brain fog.”
  11. Breast Tenderness: Some women may experience breast tenderness and swelling.
  12. Urinary Issues: Changes in pelvic floor muscles and urinary incontinence can be more common during perimenopause.
  13. Joint and Muscle Pain: Joint pain and muscle aches may become more pronounced.

Navigating the Perimenopausal Rollercoaster

While perimenopause can be a challenging phase, there are various strategies and treatments available to help manage its symptoms and make the journey smoother. Here are some science-backed approaches:

1. Consult a Healthcare Provider

The first step in managing perimenopause is to seek guidance from a healthcare provider. They can help diagnose perimenopause, rule out other medical conditions with similar symptoms, and provide personalized recommendations for symptom management.

2. Lifestyle Modifications

Lifestyle changes can have a significant impact on perimenopausal symptoms. Here are some evidence-based recommendations:

a. Diet and Nutrition

  • Balanced Diet: Eating a well-balanced diet rich in fruits, vegetables, minimally processed grains, and lean proteins can help maintain a healthy weight and support overall well-being.
  • Calcium and Vitamin D: These nutrients are essential for bone health. Increasing their intake can help prevent bone density loss, which is more common after menopause.
  • Limit Caffeine and Alcohol: Reducing the consumption of caffeine and alcohol can help manage sleep disturbances and hot flashes.

b. Exercise

Regular physical activity can help with weight management, mood stabilization, and overall health. Aim for a combination of cardiovascular exercise, strength training, and flexibility exercises.

c. Stress Management

Stress can exacerbate perimenopausal symptoms. Techniques such as meditation, deep breathing, yoga, and mindfulness can be effective in reducing stress levels.

d. Sleep Hygiene

Establishing good sleep habits is crucial for managing sleep disturbances. Maintain a consistent sleep schedule, create a comfortable sleep environment (cool and dark!), and limit screen time before bed.

3. Complementary and Alternative Therapies

Some women find relief from perimenopausal symptoms through complementary and alternative therapies. While not all of these have strong scientific backing, they may be worth exploring with a naturopathic doctor who understands perimenopause:

  • Acupuncture: Some studies suggest that acupuncture can reduce the frequency and severity of hot flashes.
  • Herbal Supplements: Black cohosh, soy, and flaxseed are among the herbs and supplements some women use to manage symptoms. However, their effectiveness varies, and safety should be considered.
  • Vitamins and Minerals: Restorative nutrients help your organ systems work at their best. Healthy adrenal gland and thyroid function are critical to enjoying your best health through perimenopause and in menopause.

4. Regular Health Checkups

Routine health checkups are essential during perimenopause to monitor for potential health risks, such as changes in cholesterol levels, blood pressure, and bone density. These assessments can guide preventive measures and treatments.

5. Supportive Networks

Joining support groups or seeking counselling can immensely benefit women navigating perimenopause. Sharing experiences and strategies with others going through similar challenges can provide emotional support and practical advice.


Perimenopause is a natural phase in a woman’s life marked by hormonal fluctuations and a range of physical and emotional symptoms. While it can be challenging, understanding the science behind perimenopause and implementing evidence-based strategies can help women navigate this hormonal rollercoaster more easily.

Remember that each person’s perimenopausal experience is unique, and what works for one individual may not work for another. It’s crucial to consult a naturopathic doctor for perimenopause to develop a personalized plan for managing perimenopausal symptoms. With the right support and strategies in place, women can embrace this phase of life with confidence and maintain their overall health and well-being.

Further Perimenopause Information and References

Certainly, here are some references for the information provided in the blog post:

  1. Gold, E. B. (2011). The Timing of the Age at Which Natural Menopause Occurs. Obstetrics and Gynecology Clinics, 38(3), 425–440. doi:10.1016/j.ogc.2011.05.002
  2. Santoro, N., & Randolph, J. F. (2011). Reproductive Hormones and the Menopause Transition. Obstetrics and Gynecology Clinics, 38(3), 455–466. doi:10.1016/j.ogc.2011.05.003
  3. Harlow, S. D., & Paramsothy, P. (2013). Menstruation and Menopausal Transition. Obstetrics and Gynecology Clinics, 40(2), 327–343. doi:10.1016/j.ogc.2013.02.002
  4. Thurston, R. C., & Joffe, H. (2011). Vasomotor Symptoms and Menopause: Findings from the Study of Women’s Health Across the Nation. Obstetrics and Gynecology Clinics, 38(3), 489–501. doi:10.1016/j.ogc.2011.05.005
  5. Santoro, N., & Randolph, J. F. (2011). Reproductive Hormones and the Menopause Transition. Obstetrics and Gynecology Clinics, 38(3), 455–466. doi:10.1016/j.ogc.2011.05.003
  6. Lethaby, A., Brown, J., Marjoribanks, J., Kronenberg, F., Roberts, H., & Eden, J. (2013). Phytoestrogens for vasomotor menopausal symptoms. Cochrane Database of Systematic Reviews, (12), CD001395. doi:10.1002/14651858.CD001395.pub4
  7. Avis, N. E., Crawford, S. L., Greendale, G., Bromberger, J. T., Everson-Rose, S. A., Gold, E. B., … Waetjen, L. E. (2015). Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition. JAMA Internal Medicine, 175(4), 531–539. doi:10.1001/jamainternmed.2014.8063
  8. National Institute on Aging. (2021). Menopause.
  9. The North American Menopause Society. (2021). Menopause 101: A Primer for the Perimenopausal.
  10. American College of Obstetricians and Gynecologists. (2020). The Menopause Years.
  11. Mayo Clinic. (2021). Perimenopause.
  12. National Women’s Health Network. (2021). The Truth About Hormone Replacement Therapy.
  13. National Institutes of Health. (2020). Calcium Fact Sheet for Health Professionals.
  14. National Institutes of Health. (2021). Vitamin D Fact Sheet for Health Professionals.
  15. Thurston, R. C., & Joffe, H. (2011). Vasomotor Symptoms and Menopause: Findings from the Study of Women’s Health Across the Nation. Obstetrics and Gynecology Clinics, 38(3), 489–501. doi:10.1016/j.ogc.2011.05.005
  16. North American Menopause Society. (2017). The role of soy isoflavones in menopausal health: report of The North American Menopause Society/Wulf H. Utian Translational Science Symposium in Chicago, IL (October 2010). Menopause, 18(7), 732–753. doi:10.1097/gme.0b013e31821fd579
  17. National Institutes of Health. (2021). Sleep Deprivation and Deficiency.
  18. National Institutes of Health. (2021). Menopause and Bone Health.

These references provide a solid foundation of scientific and medical information on perimenopause and its management.

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