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For most women, the symptoms of perimenopause come in hot and heavy and happen out of nowhere. One day you’re able to handle your wine, sleep fine, and your cycles are regular, and the next day you’re moody, having hot flashes, and unable to sleep at night.

If you’ve found yourself asking “Where did this come from? Why is this happening? And how can I make this easier?“, you are certainly not alone.

While perimenopause is majorly misunderstood and under-discussed, just like puberty, perimenpause is a transitional time that happens to every woman when her ovaries start producing less estrogen and progesterone.

And despite what most women hear from professionals, perimenopause does not have to be an awful, gut-wrenching time that you just have to endure. It is certainly nothing to be ashamed of, and there are some incredible natural remedies for perimenopause that will support your body and help you manage symptoms. Let’s do this!

What is Perimenopause?

Perimenopause is a transitional period of time when a woman’s cycle becomes irregular as she approaches menopause (the end of menstruation). The catalyst for this? A diminishing ovarian reserve.

Women are born with a specific number of eggs, and as you age, the number of eggs remaining—also known as your ovarian reserve—diminishes. As ovarian reserve declines, you stop ovulating regularly and your ovaries produce less estrogen and progesterone. When you haven’t had a cycle for over 12 months, you’re officially in menopause.

The most frustrating thing for women? Perimenopause doesn’t happen overnight. It’s the wind down of your reproductive years—sort of in the same way puberty is the ramp up to your reproductive years. Perimenopause can happen for months or even years (yes, years) and symptoms can come and go.

During perimenopause, you might have abnormally long or short cycles, or skip your period for months at a time. Because you’re not regularly ovulating, your progesterone levels drop. FSH and testosterone also drop. But the real reason you’re feeling out of sorts? Estrogen is on a bit of a roller coaster: sometimes rising high and then plummeting back to low. When estrogen is high, you have symptoms that resemble PMS, and when it’s low, you’re more likely to experience hot flashes or vaginal dryness.

When Does Perimenopause Begin (And End!?!)

Ah, the magic question. Unfortunately, there is no concrete answer to this one. The age perimenopause begins depends on a variety of factors, including your genetics, birth control use, number of pregnancies, and even your physical activity. Most women go through perimenopause in their mid to late forties. On average, perimenopause lasts about four and a half years, but it can take up to 10 years before you’ve officially reached menopause, which is when you haven’t had a period for more than 12 months.

Some research has shown certain factors can contribute to an earlier perimenopause, including smoking and even lack of sun exposure throughout your life. This matters because early menopause is associated with cardiovascular disease, osteoporosis, stroke, and all-cause mortality.

There’s no one tell-tale sign you’ve begun perimenopause. The best indicator is when you start to notice the symptoms.

If you’re not yet 40 and start experiencing the symptoms of perimenopause, don’t assume you’re just starting early. Chronic stress, which leads to elevated cortisol levels (and other hormone imbalances) can mimic perimenopause symptoms. If this sounds like you, consider working with a trusted medical provider to check your hormone levels and start working on balancing hormone levels naturally.

Signs and Symptoms of Perimenopause

Irregular Cycles. You might have a heavier or lighter than usual period, longer or shorter cycles, and skip months of your cycle at a time. During your reproductive years, this would be concerning, but in perimenopause, this is normal.

Weight Gain. The average weight gain is around 8-15 pounds, and many women find this happens even without changes to their diet and exercise routine. Other women find that perimenopause makes them less responsive (or able to recover from) exercise.

Hot Flashes & Night Sweats. Hormone fluctuations (mainly estrogen) are to blame for the radical shifts in temperature that lead to waking up drenched or a mid-day meltdown. Research shows these are experienced by almost all women, but the severity varies.

Sleep Disturbances. This one is a double-edged sword, as perimenopause not only makes falling and staying asleep harder, but many women find their ability to function on inadequate sleep plummets. If you’ve gotten away with less than 8 hours of sleep, perimenopause might just be the time when that changes!

Vaginal Dryness. Along with physical changes like increased dryness, some women also experience a decreased libido (perhaps due to lower testosterone levels).

Mood Changes. Increased rates of depression and anxiety are reported in perimenopause, even in women who’ve never experienced them before. Irritability often increases, too.

While the symptoms of perimenopause might seem random, overwhelming, and out of your control, there are so many things you can do to prepare for perimenopause before it happens, and natural remedies for perimenopause that will make the transition much easier.

Preparing For Perimenopause (Do This NOW!)

The best thing you can do to prepare for perimenopause? Take care of your health before it happens.

This means doing all the things we know helps support your body’s physiological processes—including proper hormone production, digestion, and metabolism. Essentially, if you’re reducing inflammation, balancing hormones, and supporting your body’s detoxification processes (and therefore able to properly excrete hormones) while in your 30s, your body will be able to manage the hormonal changes much better when perimenopause begins.

This includes eating an anti-inflammatory, whole-foods diet, doing regular movement and exercise, getting a good nights sleep, managing your stress, getting regular exposure to the sun, and having a good community and support system.

If your cycles are irregular in your 20s or 30s, the best thing you can do is work with a practitioner to make sure your hormones are healthy and regulate your cycle. Here are a few resources to help you get started on regulating your cycles and hormones immediately:

How to Get Your Period Back (missing or irregular periods)
How To Reverse Estrogen Dominance Naturally (heavy periods)
Natural Ways to Treat PMDD (Premenstrual Dysphoric Disorder) (If you’re experiencing PMS/PMDD)

I also highly recommend cycle syncing, which can help support proper hormone function in your reproductive years. Check out my in-depth articles on cycle syncing your food, and cycle syncing your fitness.

Lastly, getting your hormone levels tested while you’re still in your reproductive years can give you a baseline to look back on once you’re in perimenopause. All women naturally have different healthy hormone levels, so getting the baseline reading is key to know what’s happening when you retest in perimenopause. This is especially important if you want to consider hormone replacement therapy (HRT) in perimenopause. You need to know what your hormone levels were before perimenopause began.

The DUTCH test is the gold standard for accurate hormone testing. Check out my podcast episode for detailed information about the DUTCH test: Everything You Need to Know About Perimenopause & Supporting Healthy Hormone Function After 40 with Dr. Carrie Jones.

Natural Ways To Support Your Body Through Perimenopause

Don’t obsess over tracking your cycles

If you’ve been tracking your cycle for years, perimenopause can drive you crazy: your normal trends are going to be wonky, and you might not be able to discern any patterns whatsoever. It’s great to continue tracking, but don’t exhaust yourself wondering what every little blip means. This is the time to go with the new flow as much as you can.

Sleep and support melatonin production

Sleep is more important than ever during perimenopause, and harder than ever to get. Do whatever you need to do for the Zzzzzs, not limited to ear plugs, a face mask, and kicking the dog out of the bed! A wind-down routine is also key: swap alcohol and caffeine for calming chamomile tea, and wear blue light blocking glasses after sundown to promote melatonin production. Melatonin production is key for supporting your circadian rhythms.

Reduce cortisol + manage your stress

Your hormones are already in flux, you don’t want to add extra cortisol to the mix. Chronic cortisol production, which is the physiological response to stress, impacts ALL other hormones in your body, include thyroid and sex hormones. Take a look at every aspect of your life, and get serious about where you can cut back and de-stress: are you over-obligated at work? Juggling too much at home? Overdoing it at the gym? Ask for help! Read more about reducing stress and cortisol in The Adrenal Fatigue Myth: What’s Really Going On and How to Treat it.

Cut back or eliminate alcohol

“Mommy needs her wine” is the culture du jour, but the hard truth is, alcohol is not your friend in perimenopause. The liver and kidneys are already taxed detoxing changing hormones, plus it disturbs sleep. And, research has shown it can make night sweats and hot flashes worse for some women. Eliminating alcohol will help balance your hormones by getting used hormones out of your system.

Stay off the scale

Continuing your healthy diet and exercise routine is great. Obsessing over every half pound gained? It’s not doing you any favors, as it only causes elevated cortisol, which makes shedding weight more difficult. Gaining a few pounds is normal, in part because fat cells produce estrogen, and your body is trying to ensure you’ll have adequate estrogen after menopause. This is another time to remember body and weight changes are a normal part of life. Your body changes and it is OK. 

Swap cardio for weight training

Decreasing testosterone and the overall stress of perimenopause can make you less able to tolerate or recover from intense exercise, like HIIT and crossfit. If those were a regular part of your routine, you might need to cut back and swap in more gentle exercise like walking or swimming. Weight lifting is also incredible for perimenopause. It builds strength, balance, and can improve insulin sensitivity.

Eat an anti-inflammatory diet + reduce sugar

The best thing you can do to manage perimonpause symptoms naturally is to eat a whole foods, anti-inflammatory diet. Lots of vegetables, fruits, grass-fed meats, cold-water fish, pasture-raised eggs, and probiotic foods will help support digestion and balance your hormones.

Another dietary shift to make? Reduce sugar and carbohydrates. Now don’t get me wrong, no one is saying you need to go Keto. But, this is the time to experiment with shifting around your macronutrients and possibly reducing your overall carbohydrate intake. Research shows eating a lower carbohydrate diet can benefit women in perimenopause/menopause, specifically when it comes to managing insulin sensitivity. For more information on this, check out How to Prepare For Menopause & Treat Symptoms Naturally with Dr. Anna Cabeca.

Supplements to Support Healthy Perimenopause

Got the foundation in place, but need a little extra support? That’s where supplements come into play. Here are a few to consider:

B vitamins: Either a high quality multivitamin or a B complex is ideal. Make sure your vitamin contains methylated folate, NOT folic acid. Perimenopause ups the demand for nutrients, so this is a good idea even if you eat well.

Magnesium: Magnesium is the one supplement I think just about anyone can benefit from, but especially perimenopausal women. For detail information about just how important it is to supplement with magnesium, check out A Guide to the Different Types of Magnesium and listen to How and When to Take Magnesium to Support Sleep, Stress, and Hormonal Balance with Wade Lightheart.

Fish oil: Omega-3 fatty acids are important for hormone production and reducing inflammation.

Here are my recommendations for supplements for perimenopause symptoms:

For anxiety: Both L-theanine and holy basil (also known as tulsi)

For hot flashes and night sweats: Black Cohosh

To help manage stress: Ashwagandha, Rhodiola, and Vitamin C

For anything more complex, it’s best to have your hormone levels tested and work with a practitioner.

Navigate Perimenopause with Ease

I wish I could promise perimenopause will be a walk in the park, but the truth is, it’s a different journey for every woman! The good news is, there are plenty of natural ways to treat the symptoms of perimenopause, both with lifestyle shifts and supplements. You got this!

Be strong,

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