Perimenopause is a normal part of the aging process for women and will affect each woman differently. Part of demystifying perimenopause means understanding what is normal for you. Education and awareness are the first steps to understanding potential changes in the body during this transitional phase in life. If you have additional questions after reading this article, please don’t hesitate to contact me for a personalized program to get you on track to feeling your best.

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What is perimenopause?

Perimenopause is the time period that encompasses the final years of a woman’s reproductive life. It begins with the first onset of menstrual irregularity and ends one year following the cessation of menstrual periods (amenorrhea), defined as the final menstrual period (FMP). There are two stages to the perimenopause or menopausal transition: the early transition, during which cycles are mostly regular, with relatively few interruptions, and the late transition, during which amenorrhea becomes more prolonged and lasts for at least 60 days up to the FMP. (29)

Women start perimenopause at different ages. Some women may notice signs of progression toward menopause, such as menstrual irregularity, beginning in their 40s, while others may even notice changes as early as their mid-30s. Levels of estrogen, the primary female hormone, rise and fall unevenly during perimenopause. The menstrual cycles may lengthen or shorten, and women may begin having menstrual cycles during which the ovaries don’t release an egg (ovulation). (21)

Physical signs and symptoms of perimenopause

Common signs and symptoms of perimenopause include:

  • Breast tenderness
  • Concentration difficulties
  • Hot flashes
  • Irregular periods
  • Loss of sex drive
  • Mood changes
  • Periods that are heavier or lighter than normal (irregular bleeding)
  • Poor quality of sleep
  • Weight gain (23)(29)

Hot flashes are considered to be one of the physical symptoms associated with perimenopause.

Lifestyle choices and perimenopause

Some behaviors can ease the perimenopause or menopausal transition, including eating well, staying active, getting enough sleep.


Proper nutrition

Eating healthier foods, including a diet with plenty of leafy greens, fiber, and healthy fats, such as flaxseeds, avocados and fish can help reduce inflammatory processes during the perimenopausal years. Antioxidants, especially from fruits and vegetables decrease the oxidative stress that affects the number and quality of ovarian follicles. Try to incorporate foods rich in calcium and magnesium such as nuts and seeds, beans, and green leafy vegetables for the maintenance of bone health and for relieving perimenopausal symptoms such as hot flushes, insomnia, and irritability. (28)


Getting regular exercise can help reduce perimenopause weight gain and improve mood in women during the perimenopausal years. Physical activity helps relieve vasomotor symptoms such as night sweats and hot flashes. A combination of aerobic exercise (e.g., walking, jogging, swimming, and cycling) with resistance training exercises (two to three times/week) helps maintain bone and muscle mass. A combination of aerobics, resistance training, and balance exercises is the most effective in managing weight, vasomotor symptom severity and psychological distress in perimenopausal women. (28)


Sleep disturbances are a major complaint of women transitioning into menopause and have a far-reaching impact on the quality of life, mood, productivity, and physical health, especially among women with sleep disturbances. Severity and duration of sleep difficulties vary in women transitioning menopause, with some having occasional nights of poor sleep, which are bothersome and transiently impact quality of life. Others have chronic and severe sleep difficulties, associated with greater and more prolonged impact on daytime functioning, quality of life, and health.

A major factor in the increased prevalence of insomnia disorder in midlife women is hot flashes (HFs); experiencing HFs (mild, moderate, or severe) is strongly associated with a diagnosis of insomnia, with the likelihood of having chronic insomnia symptoms increasing with the severity of HF. Since some women may have sleep problems independent of HFs, other factors directly related to the menopausal transition (e.g., instability or changes in the hormone environment with progressive decreases in estradiol and increases in FSH) and/or coincident with the transition (e.g., sleep-disordered breathing (SDB) or movement disorders, mood disturbance, presence of a medical condition, life stressors) also need to be considered. (2)

Perimenopause supplements

Supplementation with specific vitamins, minerals, and medicinal herbs can be highly beneficial for reducing symptoms associated with the different stages of perimenopause.

Here are some things to keep in mind when looking for an effective dietary supplement:

  • Ensure that scientific research supports the reliability and effectiveness of the ingredients.
  • Choose a supplement that has been tested to ensure there are no heavy metals, contaminants, or other toxins present.
  • Select multi-ingredient formulas, which may provide a synergistic combination of nutrients.

Herbs for stress

Supporting the adrenal glands is an important consideration during perimenopause. The adrenal glands are responsible for the production of the stress hormone cortisol.

Recent observations indicate that the adrenal cortex of mid-aged women may play a significant role in the production of sex steroids. These studies reveal a gender-specific difference in adrenal androgen production during the aging process that is limited to the menopausal transition (MT). As a result of these observations, the adrenal cortex is now recognized as a potential important contributor to the endocrine foundation of women’s healthy aging. (17)

Adaptogens help the body adjust to stress by regulating cortisol levels, decreasing fatigue, and improving cognition. Adaptogens provide other beneficial properties such as antioxidant, cardioprotective, immune supportive, analgesic, and energy boosting properties. As a result, a combination of adaptogens may potentially be more beneficial in the reduction of the physical and psychological symptoms of chronic stress than a single adaptogen. (1)

Examples of adaptogens include:

  • Ashwagandha root
  • Astragalus root
  • North American ginseng root
  • Siberian ginseng (19)

Herbs for sleep

Many women experience sleep difficulties as they approach menopause and beyond, with 26% experiencing severe symptoms and receiving a diagnosis of insomnia. Longitudinal, population-based studies show that sleep difficulties are uniquely linked with menopause and changes in follicle-stimulating hormone and estradiol. (2)

A combination of these herbs may be beneficial for improving sleep:

  • Fleece flower (Polygonum) stem
  • Jujube (Ziziphus) fruit
  • Passionflower herb
  • Valerian root (9)(12)(24)

Herbs for balancing hormones

The stages of the menopause transition are classified by changes in menstrual bleeding, along with changes in the levels of pituitary gonadotropin follicle-stimulating hormone (FSH). The menopause transition is characterized by wide variability in both FSH and estradiol levels in the blood. (31)

In traditional Chinese medicine, Angelica sinensis (dong quai root) is used most often to treat women’s reproductive problems, such as dysmenorrhea and to improve circulation. It is suggested to relieve menstrual disorders such as cramps, irregular menstrual cycles, infrequent periods, premenstrual syndrome, and menopausal symptoms. (13) It is known for its tonifying, spasmolytic, analgesic and anti-inflammatory properties. (27)



In excess, free radicals and oxidants contribute oxidative stress, a process that can negatively affect several cellular structures, such as membranes, lipids, proteins, lipoproteins, and deoxyribonucleic acid (DNA). (26) During perimenopause, women experience greater levels of oxidative stress, due to reduced paraoxonase-1 (PON1 A) activity and elevated lipoperoxidation. Nutritional antioxidant supplementation may be an effective approach in combating the damaging effects of oxidative stress, improving perimenopausal symptoms. (35)

Antioxidants prevent free radical-induced tissue damage by inhibiting the formation of radicals and scavenging free radicals, as well as promoting their decomposition. (34)

Unfortunately, consuming just one type of antioxidant cannot protect the entire body from the many types of free radicals that occur in every organ of the body. Research has shown that antioxidants work synergistically and are far more effective when various antioxidants are ingested, not just isolated compounds. (16)

Supplemental sources of these antioxidants may be beneficial in addressing oxidative stress:

  • Bilberry extract (32)
  • Curcumin (33)
  • R-alpha-lipoic acid (3)
  • Grape berry extract (8)
  • Grape seed extract (8)
  • Green tea leaf extract (4)
  • Hesperidin (5)
  • Lutein (18)
  • Lycopene (30)
  • Maritime pine bark (14)
  • Quercetin (15)

Natural supplements can be beneficial in reducing the symptoms associated with perimenopause.

Additional supplements

In addition to various herbal supplements, other dietary supplements may be helpful during the different stages of perimenopause, including:

Flaxseed oil has been shown to be beneficial for controlling inflammation and alleviating menopausal symptoms such as hot flashes. (10) Fish oil has been shown to be beneficial in lowering the number of hot flashes experienced by perimenopausal women. (20)

The bottom line

Perimenopause is a normal part of the aging process. It’s important that women be aware of the changes they will experience and the ways in which they may address possible symptoms. Your integrative healthcare practitioner can help you determine the best approach and dietary supplements for your needs.

Written by

Joanne Carr, R.H.N., B.A., ESC.

Medically reviewed by

Dr. Christopher Knee, ND

*This handout was developed and medically reviewed by Fullscript’s Integrative Medical Advisory team.

*These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.