Perimenopause: A best of both worlds approach

Perimenopause is the time leading up to menopause when hormone levels start to fluctuate. For some women the changes are subtle, for others they can feel overwhelming. You might notice shifts in sleep, mood, energy, metabolism, or libido; all while juggling work, family, and everyday demands.

As a naturopathic herbalist trained in traditional herbal medicine and evidence-based care, I see perimenopause as an opportunity to reset and support your body. The most effective results often come from combining lifestyle, nutrition, and herbal medicine; and when needed, adding Menopausal Hormone Therapy (MHT, previously known as HRT).

1. Start with the Foundations

Before we think about supplements or prescriptions, we begin with the basics that help your body function at its best.

Sleep: Deep, regular sleep supports hormone balance and stress recovery.

Movement: A mix of strength and aerobic exercise improves bone health, mood, and energy.

Stress management: Calming the nervous system with breathwork, meditation, time in nature, or gentle yoga can help restore progesterone balance.

Connection: Emotional wellbeing, friendships, and community are essential to thriving through this transition.

2. Nourish from the Inside Out

Nutrition in perimenopause is about stability and nourishment, not restriction. Balanced blood sugar helps regulate energy, mood, and hormonal fluctuations.

• Protein: Aim for around 1–1.2 g per kg of bodyweight to maintain muscle and metabolism.

• Fibre: Supports gut health and hormone clearance.

• Healthy fats: Omega-3s from fish, flaxseed, or algae help reduce inflammation and support mood.

• Phytoestrogens: Flax, tempeh, and legumes contain natural plant oestrogens that can gently support hormone balance.

  
  

3. Herbal Support for the Transition

Herbal medicine offers gentle yet effective support during perimenopause. Some commonly used herbs include:

• Withania (Ashwagandha): Promotes calm and better sleep.

• Sage: Traditionally used to reduce hot flushes and night sweats.

• Rehmannia: Balances adrenal and hormonal function.

• Shatavari: Nourishes the female reproductive system.

• Lemon balm: Supports the nervous system, has a calming effect.

• Reishi and Lion’s Mane mushrooms: Help with stress resilience, immune health, and cognition.

Herbal formulas are most effective when prescribed individually, tailored to your unique symptoms and health picture.

4. When to Consider MHT (HRT)

Sometimes lifestyle and natural therapies aren’t enough on their own, and that’s completely okay. MHT can be a safe and effective option for women experiencing severe hot flushes, night sweats, sleep problems, or bone density loss.

An integrative approach means using both natural therapies and MHT thoughtfully, ensuring your body has the nutritional and adrenal support it needs to respond well. Working with both a naturopath/herbalist and your GP helps ensure your care is personalised and balanced.

5. Integration Is the Key

Perimenopause isn’t a disease, it’s a natural transition that can become a time of renewal with the right support. Combining the wisdom of herbal and lifestyle medicine with the benefits of modern hormonal therapies allows you to find what works best for your body and your values.

You don’t have to choose between natural and conventional care. You can have the best of both worlds.

Ready to Feel Like Yourself Again?

If you’d like personalised support through perimenopause, book a consultation with me to explore the most effective integrative options for your body.