These natural perimenopause tips are your complete guide to feeling great in your 40’s and beyond! We cover it all – how to shift your diet and exercise, perimenopause supplements, what lab tests to order, benefits of bioidentical hormone replacement, and more!
Note from Dena: This post was co-written with Mollie Francis, Dietetic Intern, as part of a research partnership between Back To The Book Nutrition and post-graduate nutrition students from the University of Houston.
Let’s face it – perimenopause can be a drag. Heavy periods, hot flashes, mood swings, and you keep losing your car keys. (Find out whether you’re in perimenopause here!)
And, while you can’t turn back the clock, there is a lot you can do to optimize hormones and feel great through your 40’s and beyond!
11 Natural Perimenopause Tips
1. Optimize your real food diet for Perimenopause
Eating a variety of minimally processed “real food” from both plants and animal sources is important for health at every stage of life. But you’ll want to pay extra attention to these aspects during perimenopause:
Women in general don’t eat enough protein. But midlife women need to be even more attentive to meeting protein needs for the following reasons:
- Prevents sarcopenia – sarcopenia is muscle wasting (triggered by declining estrogen and testosterone), a significant risk factor for osteopenia and osteoporosis
- Helps balance blood sugar – increasing protein displaces carbs in the diet, and reduces blood sugar spikes from the carbs you do eat during this time when your body is becoming more insulin resistant
- Supports immune function – amino acids in protein are needed to make immunoglobulins – especially important in midlife when women are more prone to immune suppression and autoimmunity
- Supports mood – protein is needed to make neurotransmitters like serotonin, dopamine, and GABA to help with depression and anxiety that often peak during perimenopause
- Provides key vitamins and minerals in an easily digested form – B vitamins, zinc, iron, and others to support stress management, optimal stomach acid production, and antioxidation needed for healthy aging
EAT FISH 4 TIMES PER WEEK
Wild caught fish (salmon, tuna, etc.) is a great source of anti-inflammatory omega-3 fatty acids – specifically, EPA and DHA. To a much lesser degree, plant foods like algae, walnuts, and flax contain fatty acids that the body can use to make omega-3’s. Lowering inflammation can help with menstrual cramps, weight management, headaches, cardiovascular risk, and joint pain that are more common in perimenopause.
KEEP YOUR CARBS IN CHECK
Very low carb diets aren’t necessary or helpful, but shaving off some of the excess (in favor of more protein!) can help offset the insulin resistance that’s setting in at this time. Obviously, cutting back on desserts, wine, and extra bread should be the primary focus here, not eliminating fruits, starchy veggies, beans, and other nutrient rich carbs.
EAT THE RAINBOW
Choose a variety of brightly colored fruits and vegetables daily for fiber, antioxidants, and immune supportive nutrients that promote healthy aging.
INCLUDE CRUCIFEROUS VEGGIES DAILY
The indole-3-carbinol (I3C) and other compounds in cruciferous (aka: “Brassica”) vegetables support detoxification, lower inflammation, and reduce cancer risk – all of these are concerns during perimenopause.
Examples of cruciferous vegetables include arugula, broccoli, Brussel sprouts, cabbage, collard greens, cauliflower, and kale.
INCORPORATE FLAX & OTHER PHYTOESTROGENS
These are perfect during all stages of perimenopause because they can either increase or lower net estrogen activity, depending on the body’s need:
- If estrogen is high (more common in pre-perimenopause and Stage 1 of perimenopause) – phytoestrogens will compete with stronger human estrogen to fill up estrogen binding sites in the body (think of these like parking spots), thus reducing the amount of stronger natural estrogen that can bind, lowering estrogenic activity.
- If estrogen is low (more common in Stages 2 & 3 of perimenopause and in menopause) – fewer binding sites/parking spots are filled, so adding phytoestrogens fills up more of them, raising estrogenic activity.
- Ground flaxseed
- Various other beans/peas
- Brazil nuts
- Pumpkin seeds
- Various other nuts/seeds
- Sweet peppers
- Sweet potatoes
- Fresh parsley
- Multi grain bread or muesli
* A note on soy: Whole soy foods like soybeans/edamame, tofu, and tempeh are recommended, not highly processed soy products like soy protein isolate, soybean oil, etc. Since nearly all soybeans in the U.S. are genetically modified and heavily sprayed with pesticides and other chemicals, choose organic soy products as much as possible.
CHOOSE HEALTHY FATS (INCLUDING CHOLESTEROL)
Which fats are healthy has been hotly debated by scientists and doctors for decades. The summary of quality research indicates these are important fats to prioritize during midlife:
- Omega-3 fats – lower inflammation; best sources: fish and seafood, especially higher fat varieties like salmon and sardines – ideally, buy wild caught
- Monounsaturated fats – lower inflammation and improve insulin sensitivity; best sources: olives, extra virgin olive oil, avocados, almonds, cashews, peanuts
- Cholesterol – needed for hormone production (estrogen, progesterone, and testosterone) and linked to better brain health as we age; best sources: animal fats (lard, tallow, suet, etc.) and fatty cuts of meat – ideally, buy from local farmers whose animals graze on organic grass and aren’t treated with hormones, antibiotics, etc.
At the same time, minimizing polyunsaturated fats from refined oils like canola, vegetable, sunflower, safflower, etc. can help reduce inflammation and lower cardiovascular disease risk.
CUT BACK ON CAFFEINE AND ALCOHOL
Both caffeine and alcohol are stressors that challenge blood sugar balance and can disrupt sleep (no one needs more of that in this stage of life!). Omitting these can be helpful for some but isn’t always necessary. If you choose to consume them, use these guidelines:
- Caffeine – Caffeine has about a 6 hour half life (it takes 6 hours for half of it to leave your system, then another 6 to decrease that half by half, etc.). To prevent disruption to overnight “rest and repair” functions that happen during deep sleep, limit caffeine to no more than 1-2 servings in the morning hours. For very sensitive individuals, even foods with lower caffeine levels (chocolate, etc.) can disrupt sleep when consumed in the evening. Combine caffeine with a balanced meal to minimize it’s impact on cortisol and blood sugar.
- Alcohol – If you do drink, limit to 1-2 drinks per week to minimize inflammation, disruption to the gut microbiome, and cancer risk. Drink with meals and not too late in the evening to minimize blood sugar imbalance and sleep disturbance.
2. Reduce and Manage Stress
Stress reduction is a key factor in ensuring the smoothest possible perimenopausal (and post-menopausal) experience. That’s because, as the ovaries decrease hormone production, you’ll become more reliant on the adrenal glands to produce small amounts of of estrogen, progesterone, and testosterone.
But the adrenals (in partnership with the hypothalamus and pituitary glands in your brain) are already busy with their primary job of making adrenaline and cortisol in response to stress. It’s not hard to see how too much pressure on the adrenal glands could result in even lower production of hormones, especially if they’ve been struggling for years or decades to keep up with stress demands.
This HPA axis dysfunction (sometimes referred to as “adrenal fatigue”) is one reason why high achieving, type A women sometimes have a rougher perimenopausal transition.
WORK ON ALL 3 ASPECTS OF STRESS MANAGEMENT:
- Reduce Negative Stressors – Poor sleep, unhealthy relationships, and overcommitting are unhealthy stressors that can throw hormones off balance.
- Moderate (“Hormetic”) Stressors – Hormetic stress is stress that is helpful only if the body has reserves to recover from it. Exercise, low to moderate alcohol consumption, sauna, and intermittent fasting are hormetic stressors.
- Increase Stress Reducers – Deep breathing exercises, spending time in nature, prayer, laughing, enjoying time with family and friends, spiritual practices, and gentle yoga and stretching activate the parasympathetic nervous system, reducing anxiety and stress.
3. Balance Cardio with Strength & Stretching
When they gain a few extra pounds during perimenopause, many women make the mistake of pushing harder in their workouts. This may have worked in the past, but is likely to backfire on you during this phase of life because of the stress it can place on the body.
- Go Easy on the Cardio – Dial back the long duration and/or high intensity cardio workouts (running, kickboxing, spin, HIIT, etc.), and intersperse them with more low intensity exercise, strength training, and rest days.
- Strength Train – Whether you do body weight exercises (lunges, push ups, etc.), band workouts, or lift weights, preserving and building muscle is critical in this stage of life when most women are losing it due to lower estrogen and testosterone levels. Increased muscle mass increases your metabolic rate, helps with balance to prevent falls, and helps preserve bone mass as you age.
- Stretch, Stretch, Stretch – Stretching after each workout, when your body is warm, can increase flexibility and prevent injury.
- Schedule Rest Days – Taking 1-3 rest days per week can help you recover from workouts and get more out of your exercise on the days you do work out.
4. Get Great Sleep
Getting 7-9 hours of quality sleep is so important for hormone balance and overall health, and yet it’s an area where so many perimenopausal women struggle.
During this stage of life, you’ve got to get serious about going to bed on time (ideally by 10pm), and developing a relaxing evening routine as your brain and body may need more help winding down for sleep.
5. Switch to Nontoxic Makeup, Cleaning, and Personal Care Products
The average woman is said to use at least 12 personal care products daily, not to mention cleaning supplies, plastics, and other harmful chemicals she encounters!
And at this stage of life when keeping hormones balanced is harder than ever, minimizing hormone disrupting chemicals is something we all need to be working toward.
6. Check (the Right) Labs
The labs in the graphic above are great considerations in your 40’s. Getting the right lab tests ordered is half the battle – but interpreting the results to not only rule out disease (i.e., you’re not diabetic), but also to help you optimize your health (i.e., you’re not diabetic, but your blood sugar markers all indicate poor blood sugar regulation).
If you’ve been told all your labs are “normal” but you have symptoms of imbalances in these areas, consider working with a holistic or functional medicine provider like Dena to help you take a closer look.
Your 40’s is also the time to schedule preventive screening tests like mammogram, colonoscopy, or others relevant to your health concerns.
7. Stop Suppressing Symptoms & Fix the Root Cause of Your Health Issues
Low progesterone, Hashimoto’s , IBS, anxiety, and other conditions all become more common during perimenopause. Usually, these have been brewing under the surface for a while but, in our 40’s, they become harder to ignore. Remember, symptoms are a signal from your body that something needs attention.
So instead of reaching for the Advil or filling a prescription just to silence the symptom so you can get on with life, stop and ask what’s causing it. For example:
- Anxiety could mean low progesterone.
- Joint pain could be caused by autoimmunity.
- Hair thinning and loss could point to low thyroid hormone.
- Nausea, heartburn, or indigestion after heavier meals could be from low stomach acid, SIBO, or sluggish bile flow.
Dena or another holistic/functional medicine practitioner can work in conjunction with your medical team to help you get the right testing to identify root causes, and create a personalized plan to optimize your eating, supplements, and lifestyle to improve or even reverse the underlying imbalances.
8. Perimenopause Supplements
When it comes to feeling great during perimenopause and beyond, supplements can help bridge the gap when food alone doesn’t cut it.
Supplements that help many women in their 40’s:
- High quality multivitamin-mineral like my Daily Foundation
- B Complex (Daily Foundation includes B complex)
- Magnesium glycinate or magnesium threonate
- Vitamins A,D,E, and K2
- High Quality Fish Oil
- Antioxidants (CoQ10, L-carnitine, NAC, ALA, zinc, etc.)
- Herbs to support the stress axis (ashwagandha, rhodiola, valerian, holy basil, etc.)
- Herbs to support hormone related symptoms (chaste tree/vitex, maca, etc.)
- Amino acids to support neurotransmitters if needed (5-HTP, L-Theanine, etc.) – do not combine with medications without first speaking to your prescribing physician
Always talk to your practitioner first before taking supplements.
9. Consider Bioidentical Hormone Replacement
“Bioidentical” simply means the chemical structure is identical to the hormones we make naturally. Because of this, Bioidentical Hormone Replacement Therapy (BHRT) appears to be even more beneficial than synthetic hormone replacement (not identical to our natural hormones), and with lower risk.
There’s no need (and you probably shouldn’t!) wait until menopause to start hormone therapy – many, many perimenopausal women benefit from bringing it in earlier to close the gap as their own hormone production wanes.
Hormones used may include:
- Progesterone – usually introduced first since levels start dropping on Stage 1
- Estrogen – can be helpful in Stage 2 and/or Stage 3 of perimenopause
- DHEA – not always used, but can help during Stages 2 and/or 3
- Testosterone – not always used, but can help during Stages 2 and/or 3
- Less bone loss/decreased risk of osteopenia & osteoporosis
- Lower cancer risk
- Higher libido
- Fewer hot flashes and night sweats
- Better body composition
- Improved sleep
- Better mood
- Less brain fog
- More energy
Bioidentical hormone replacement of any kind should be prescribed based on testing and monitored by a doctor or other licensed healthcare provider. Talk with your provider to determine if they are right for you.
10. Get Pelvic Floor Physical Therapy
Many women have been ignoring pelvic floor issues for years when their 40’s roll around. But pelvic floor dysfunction and natural perimenopausal changes to body composition, hormones, etc. can create a perfect storm. Ask for a referral to a pelvic floor physical therapist (often covered by insurance!) if you struggle with these issues:
- Urinary leakage or urgency
- Vaginal infections (yeast infections, bacterial vaginosis, interstitial cystitis)
- Pelvic pain (related to intercourse, your menstrual cycle, or other issues)
- Low back pain
- Poor posture and core strength
11. Embrace Your Body’s Natural Changes
Embrace this phase of life!
Yes, it may come with a few more wrinkles and a few extra pounds…and that’s okay! But aim to accept and support your body so it can help you accomplish your deeper purpose and enjoy new midlife opportunities.
Enjoy freedoms that you haven’t had in years as your kids get older and eventually leave home. Turn a passion into a new career. Plan an adventure. Make new friends or hang out with old ones. Spend more quality time with the family. Take care of YOU!
About the Co-Author:
Mollie Francis is currently a dietetic intern at the University of Houston working toward her goal of becoming a Registered Dietitian. She is a Group Fitness Instructor and has a passion for helping others achieve wellness through diet and exercise. In her free time, Mollie enjoys running and spending time with her family.
Disclaimer: Information on this site is intended only for informational purposes and is not a substitute for medical advice. Always consult with a trusted healthcare provider before implementing significant dietary change. Read additional disclaimer info here.