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Perimenopause: A Tale of Erratic Hormones

perimenopause, treatment for perimenopause
understanding perimenopause and treatment options

What’s Going On…

Perimenopause is a natural transition in a woman's life leading up to the loss of her menstrual cycle. This transitional time can be particularly confusing because it can almost be defined in one word: irregularity. Estrogen production during this phase becomes unpredictable, meaning some months may feel like smooth sailing, while others are ridden with symptoms. Hormone fluctuations can begin in a woman’s 40’s (though sometimes earlier), and may last several years before your period officially leaves the party. While perimenopause isn't a disease, there are some common symptoms to be aware of including:

  1. Irregular periods

  2. Change in bleeding

  3. Hot flashes

  4. Night sweats

  5. Mood changes (including anxiety and depression)

  6. Insomnia

  7. Vaginal dryness

  8. Decreased libido

  9. Weight gain

  10. Forgetfulness

The goal of perimenopause treatment is not to “regulate/balance/fix” your hormones… What’s needed is to educate women on natural hormonal fluctuations, and to smooth out the hormonal symptoms they are experiencing. This is a subtle, but important distinction. There are many non-hormonal treatments available to help manage symptoms, and it's important to discuss these options with your healthcare provider to find the best plan for you.

Nutritional support Nutrition habits should place more value on what you ARE eating, and ensure nutritional adequacy, rather than taking foods away. We must prioritize things like protein, adequate calories, vegetables, fruits, and healthy fats. Evidence suggests a balanced Mediterranean diet can be helpful through the perimenopause phase, which focuses on lean proteins, a variety of colourful fruits and veggies, fostering a positive relationship with food, and of course… extra virgin olive oil! When considering what to moderate or reduce in the diet, best evidence points towards alcohol and caffeine. Sometimes consumption of these two increases as a means of coping with mood changes and lost sleep, however in the long run they can worsen perimenopause symptoms.

A Note on Soy Soy products have been suggested as a natural way to manage perimenopause symptoms, as they contain compounds called phytoestrogens. These compounds can interact with estrogen receptors in the body by turning them on or off, and may weakly mimic natural estrogen. This modulation of estrogen receptors can reduce symptoms of perimenopause and menopause in some women. The effects of dietary soy, specifically in relation to estrogen metabolism, is quite nuanced. There has been debate in the past of whether soy is helpful or harmful in the context of hormone-dependent cancers (particularly breast). While significant evidence suggests a positive or neutral impact of soy consumption, it is always best to discuss your personal health history with your healthcare provider. This is a conversation I have regularly at Naturally Inclined and is a wonderful discussion starter to educate and empower patients.

Other Treatment Various treatment approaches can help manage perimenopause symptoms. These include supplements and acupuncture to help with sleep, mood, and PMS. Additionally, Hormone Replacement Therapy (HRT) should be an ongoing discussion with your providers, as it can safely be administered and have profound effects on the menopausal experience. Perimenopause is not a “one size fits all” approach, so getting clear on your symptom picture and goals is essential for creating a plan that best serves your needs.

Key Takeaways While perimenopause is a natural stage in every woman’s life, you shouldn’t be expected to spend several years of your life grappling with symptoms. Waiting for periods to end is not a strategy for coping with this transitional stage, and you deserve a plan that allows you to embrace this next season of your life. Navigating this time of life need not be a DIY endeavor! If you’re finishing this post and thinking it’s time for some support in your health journey, please don’t hesitate to reach out to one of our providers here at Naturally Inclined Health.


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  3. Santoro N. Perimenopause: From Research to Practice. J Womens Health (Larchmt). 2016 Apr;25(4):332-9. doi: 10.1089/jwh.2015.5556. Epub 2015 Dec 10. PMID: 26653408; PMCID: PMC4834516.

  4. Santoro N, Roeca C, Peters BA, Neal-Perry G. The Menopause Transition: Signs, Symptoms, and Management Options. J Clin Endocrinol Metab. 2021 Jan 1;106(1):1-15. doi: 10.1210/clinem/dgaa764. PMID: 33095879.

  5. Zhao TT, Jin F, Li JG, Xu YY, Dong HT, Liu Q, Xing P, Zhu GL, Xu H, Miao ZF. Dietary isoflavones or isoflavone-rich food intake and breast cancer risk: A meta-analysis of prospective cohort studies. Clinical nutrition. 2019 Feb 1;38(1):136-45.


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