The Integrative Medicine Guide to Perimenopause

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Perimenopause can be a confusing time in a woman’s hormone journey, because there are many times throughout a woman’s life where problems like painful periods, mood swings, and weight gain are dismissed as ‘normal’ parts of womanhood. Perimenopause is no different, but with integrative medicine, you have more solutions than ever before.

Keep reading to learn the signs, symptoms, and functional treatments to support a healthy and comfortable transition into menopause.

What Is Perimenopause?

Perimenopause is the time between a woman’s reproductive years and menopause. 

While your period is still making regular occurrences, symptoms like acne, weight gain, and mood swings have popped up, and you’re not sure if you should be concerned, or if you’re just going crazy! 

You’ve likely heard the word menopause, and maybe have a basic understanding about what it is: Your period stops, sex hormones like estrogen decrease, and you can no longer become pregnant.

But these shifts don’t happen overnight, and often begin several years before the actual onset of menopause–during this time a woman is considered to be perimenopausal.

During perimenopause is when many women begin to feel the first symptoms indicating that menopause is on the horizon, as your body prepares to stop ovulating and decreases hormone production. This process happens in three main stages.

Stages of Menopause

Perimenopause: Stage 1; Hormones begin to decline; periods become erratic/irregular.

Menopause: Stage 2; Hormones continue to decline; symptoms like hot flashes may increase; periods become more and more infrequent; ovulation ceases.

Post-menopause: Stage 3; Occurs the day after the one-year mark of no period.

After the one year mark of no period, a woman is said to have completed menopause and is now considered post-menopausal.

Signs & Symptoms of Perimenopause

Perhaps you’re noticing some changes in your cycle, or other symptoms. If you’re nearing menopause, here’s what you might notice or feel:

  • Mood changes (depression, anxiety, irritability)
  • Low libido
  • Irregular menstrual cycles (shorter periods, longer cycles, etc.)
  • Hot flashes
  • Insomnia
  • Fatigue
  • Weight gain (often around the abdomen)
  • Hair loss

The most common symptom of perimenopause is irregular periods. Cycles will become increasingly irregular until your period stops happening altogether.

Find out if your symptoms are due to perimenopause by working with a provider at CentreSpringMD.

What Age Does Perimenopause Happen?

The average age in the U.S. for menopause is 51 (1). Perimenopause can begin as little as a few months before menopause, or as long as several years. The average age for perimenopause is about 47.

How Long Does Perimenopause last? For most women, perimenopause lasts about four years, but for some it may be as short as several months or continue for as long as ten years. 

If you’re experiencing perimenopause symptoms prior to age 40, it’s important to contact your doctor to rule out other potentially more serious causes.

How Do You Know If You’re Perimenopausal?

While identifying signs and symptoms of perimenopause (or menopause) will give you a reasonably clear sign that you’re transitioning into menopause, your integrative medicine doctor will help you confirm, and explain treatment options to support your body during this change.

Testing for Perimenopause

Your integrative medicine doctor will most likely test your estrogen levels and another hormone called follicle-stimulating hormone (FSH).

Estrogen is the most important hormone for menstrual cycle regulation, while FSH helps support estrogen production. If FSH is high, it can be because the ovaries are producing less estrogen, and your body is making more FSH to try to correct this, indicating that you’re approaching menopause.

Normal FSH levels in adult women range from 4.7 to 21.5, with anything above 30 indicating the ovaries are decreasing their production of estrogen (2,3).

Whether you’re approaching perimenopause or not, the only way to have a clear picture of what your hormones are doing is to get them tested. Schedule a test with a provider quickly and easily.

Do You Still Get A Period During Perimenopause?

Most women are still cycling during perimenopause, although cycles may gradually become longer, with shorter bleeds during this time.Perimenopause solutions with integrative medicine

Pregnancy During Perimenopause

Since a woman can still be ovulating during perimenopause, there is still a chance you can become pregnant. 

Perimenopause and Weight Gain

Weight gain in perimenopause is common, and many women report a change in how their weight is distributed with increased fat stored around the abdomen versus the lower body. 

This is mostly due to two factors: A drop in the hormone estrogen (which prior to menopause causes female bodies to distribute fat in the lower body) and a decrease in muscle mass (4). 

This decrease in muscle mass, coupled with changing hormones, means your calorie furnace isn’t burning quite as hot as it once was, resulting in a gradual slowing-down of your overall metabolism.

Mood Swings

If you feel like perimenopause (or menopause) is making you crazy, you’re not alone! Your body is making some significant hormonal transitions and this can have a very noticeable effect upon your mood. 

During perimenopause, hormones like estrogen are decreasing, and FSH increases, but they often don’t do so in an organized manner–sometimes fluctuating drastically from cycle to cycle (5). This creates mood swings like many women have never felt before.

A decrease in progesterone can cause you to feel irritable, while decreases in testosterone and estrogen can zap your energy and libido.

Integrative Medicine Treatment for Perimenopause

Though perimenopause isn’t a medical problem, but a natural process, there are many reasons why women need extra support during this time. By optimizing diet, supporting the adrenals, and leveraging the right functional medicine treatments, perimenopause can be a much more comfortable time.

Hormone Replacement Therapy

Hormone replacement therapy (HRT) is one option your integrative medicine doctor can speak with you about during menopause and perimenopause. He or she will discuss the benefits and risks for your individual needs. 

HRT is a treatment intended to replace the drop in sex hormones with a small dose of hormones normally administered in a pill, patch, injection, or cream.

Hormone replacement therapy involves synthetic or bioidentical hormone replacement, although many functional medicine doctors choose bioidentical hormones, which are more similar to the body’s own hormones. Bioidentical hormones reportedly lead to greater patient satisfaction and the reduction in potential side effects and risks posed by synthetic hormone replacement.

Is hormone replacement therapy right for you? Discuss benefits and risks at your next appointment.

The 7 Best Supplements for Perimenopause

In addition to diet and lifestyle changes to support hormone shifts, your integrative doctor might also discuss with you various supplements to help manage side effects like hot flashes, mood swings, and low libido.

1. DIM

Supports metabolism of estrogen in the liver, and can reduce symptoms of estrogen dominance like sore breasts, irritability, and heavy periods. Since progesterone declines with the stopping of ovulation, estrogen can often dip and rise wildly in perimenopause, unchallenged by progesterone.

2. Maca

This ancient Peruvian root supports a healthy libido, and a healthy hormone balance. In one study, supplementation with 2 grams of maca daily significantly reduced FSH levels, while increasing estrogen and progesterone. These women reported “substantially reduced feelings of discomfort” during menopause (6).


Once the ovaries stop producing estrogen, the adrenal glands take over, secreting DHEA which is then converted to estrogen.

DHEA can be supplemented (under the supervision of your provider) and is a useful treatment for increasing estrogen and testosterone production. DHEA is also used in topical creams and lubrication to increase natural vaginal lubrication to make intercourse more enjoyable and comfortable.

4. Adaptogens

Incredibly beneficial for supporting the body during times of stress, adaptogens cover a wide range of options such as rhodiola and eleuthero, two botanicals which are useful to promote a stable mood and stress response within the HPA axis.

5. Anti-inflammatories like omega-3s and turmeric

Anti-inflammatory supplements like turmeric are beneficial for gut health, inflammation, microbiome health, and have antioxidant capability, which can help modulate some symptoms of perimenopause (7). 

6. Black cohosh

Most often recommended for hot flashes, the active constituents in black cohosh–triterpenoids, isoflavones, and aglycones–are thought to be responsible for the suppression of luteinizing hormone, which can help modulate the physical and psychological menopauses symptoms (8).

There have been reports of liver toxicity, and other milder side effects with black cohosh, so it’s a good idea to discuss the supplements you’re taking with your integrative medicine doctor.

7. Methylated B vitamins

B vitamins play a crucial role in supporting the adrenal glands as they make DHEA to be converted to estrogen. 

In times of stress, metabolic demand for B vitamins increases, as adequate amounts of methylated B vitamins can help support optimal adrenal function.

Note that synthetic folic acid and methyl-folate are not used the same way in the body. If you have MTHFR, your body may not be able to adequately convert man-made folic acid to the active form your body can use. 

Perimenopause Support with Functional Medicine

Perimenopause symptoms are the first sign that menopause is one the horizon, and while many women feel daunted by this shift in hormones, perimenopause doesn’t have to be miserable. Functional medicine treatment for perimenopause will support a woman’s hormone balance, as well as overall comfort, as her body navigates through this change. 




hormones, Perimenopause

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These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any diseases.
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