Perimenopause 101: What’s Happening, What Helps, and How to Care for Yourself
If your cycles, sleep, mood, or energy suddenly seem to be doing their own thing, you’re in the right place!
Perimenopause is a normal life stage but the day-to-day experience can feel anything but normal.
This guide walks you through what perimenopause is, the most common symptoms, when it typically starts, how it ends (menopause), and a clear look at holistic and conventional treatment options. You’ll also find my favorite and trusted professional-grade supplement suggestions, that I personally use and recommend to my patients, with a link for an easy way to shop them via my online dispensary, Fullscript.
What is perimenopause?
Perimenopause is the transition time before menopause when ovarian hormone production becomes more erratic. Estrogen and progesterone fluctuate, and ovulation becomes less predictable. This hormonally “wavy” period is what drives the symptoms so many people notice. Perimenopause ends when you reach menopause, which is diagnosed after 12 consecutive months without a menstrual period (not due to pregnancy or a medical/surgical cause). The average age of menopause is ~51. ([ACOG][1])
When does it start and how long does it last?
There’s a wide range, but most people enter perimenopause in their 40s and sometimes late 30s. This transition period, our lovely perimenopause, commonly lasts about 2–8 years, and some of my patients report about 10 years. ([Cleveland Clinic][2])
Common perimenopause symptoms
Because our sex hormones affect many systems, symptoms can touch nearly every part of life:
Cycle changes: shorter or longer cycles, heavier or lighter flow, more PMS
Vasomotor symptoms: hot flashes & night sweats
Sleep issues: trouble falling or staying asleep
Mood & cognition: irritability, anxiety, low mood, brain fog
Energy & metabolism: fatigue, changes in weight or body composition
Genitourinary symptoms: vaginal dryness, discomfort with sex, more UTIs, bladder urgency
Skin & hair: dryness, acne shifts, hair shedding
Libido changes
Tip: If bleeding is very heavy, very frequent, or you have bleeding after sex or after menopause, check in with your GYN promptly.
How menopause is defined (and why it matters)
Menopause is a point in time in which 12 months have passed without a period and is not correlated with a lab value. FSH tests can fluctuate, may be used to track where you are in the transition they aren’t needed to “prove” menopause in most cases. Knowing this helps with planning because you can still get pregnant in perimenopause, since you are still ovulating, although typically not every month, and treatment choices. ([ACOG][1])
Treatment options: holistic & conventional, side-by-side
START HERE
Foundations first
These are powerful on their own and play nicely with medical therapies, should you choose to include them:
1. Sleep hygiene + stress care
Prioritize consistent bed & wake times, a cool dark room, morning sunlight exposure, and consistent wind-down routines like avoiding screens, limiting/avoiding caffeine and alcohol. Cognitive behavioral therapy (CBT), particularly for insomnia or hot flashes, has evidence for easing how bothersome symptoms feel. ([UW Departments][3])
2. Nutrition that steadies energy
High-quality protein at each meal (like wild-caught seafood, grass-fed meats, organic legumes), fiber-rich colorful plants, and healthy fats support satiety, blood sugar, hormone balancing, thyroid and gut health. Aim for calcium-rich and vitamin D-containing foods for strong bones.
3. Strength + cardio
Resistance training 2–4x/week helps maintain lean mass and bone strength. I recommend to add in brisk walking, cycling, or interval training for heart health.
4. Pelvic & sexual health
Consider using clean, pH balanced lubricants and/or moisturizers and, when appropriate and in collaboration with your holistic functional doctor and/or GYN, local vaginal estrogen, can improve comfort and sexual wellbeing. Many of my patients find that pelvic floor PT helps with leakage and reduces pelvic pain.
Conventional medical options
Menopausal hormone therapy (MHT/HRT)
This is a commonly used treatment for hot flashes and/or night sweats and for genitourinary syndrome of menopause. HRT also helps prevent aged related bone loss and has been shown to have benefits for cardiac health and cognitive function as we age.
The latest recommendations for age-related hormone decline are generally to start MHT before age 60 or within 10 years of menopause in appropriately screened patients.
If you have a uterus, estrogen is typically paired with a progestogen for endometrial protection. Therapy is individualized (type, dose, route), and many people use it short-term for symptom relief. ([Dutch Menopause Society][4]) Be sure to have an open and honest discussion with your health care provider to discuss all of your options and which may work best for you during this season of your life.
Diagnostic Testing - DUTCH Test
In my clinic, I recommend completing a DUTCH (dried urine) hormone test to deeply evaluate your unique hormone levels, metabolism, and detox pathways. Included in this evaluation is the way your body uses and clears estrogen. Think of it like traffic on three roads: the “2-road” (the safer route), the “4-road,” and the “16-road.” Too much traffic on the 4- or 16-roads over time can raise estrogen-related cancer risk, while more traffic on the 2-road is generally protective.
The DUTCH test also shows how well your “cleanup crew” or detoxification works. Phase 1 (first pass in the liver), Phase 2 (adding a “tag” so estrogen can leave safely via methylation, sulfation, or glucuronidation), and the gut “exit door” (your microbiome/estrobolome) that helps used hormones leave the body.
From a professional standpoint, this lets me personalize care: if your results show slow cleanup in one area, we can support it with targeted lifestyle steps (sleep, fiber, hydration), foods (cruciferous veggies), and supplements if appropriate (like magnesium or methyl donors), and make a safer plan for symptoms and long-term health. If your traffic patterns are not ideal, we can modify nutrition, lifestyle, and add in some powerful nutraceuticals to encourage traffic down the safer routes.
Who is it best for? I find DUTCH especially helpful if you have irregular or heavy periods, big PMS swings, hot flashes/night sweats out of the blue, mood or sleep trouble, or if you’re considering or already using hormone therapy and want a more precise, safer approach. It’s also useful when skin changes, low libido, or fatigue don’t match basic bloodwork. I also recommend this for any women with a personal or family history of estrogenic cancer.
In simple terms: DUTCH tells us what your hormones are doing all day, where they go, and whether the “garbage trucks” that take them out are on schedule so we can fix the route if needed and keep you feeling your best while lowering long-term risks. I think it is a value test for all women and provides actionable information that is not only empowering, it can have huge impact on your current and long-term health.
3 of my Favorite Targeted Nutraceutical Support for Perimenopause (professional-grade)
1. Femmenessence PRO (Organic Maca)
Organic Maca (Lepidium meyenii) is an adaptogenic root used traditionally for energy, mood, and sexual health. Early clinical research suggests potential benefits for menopausal symptoms, including hot flashes. ([PMC][6]) They offer a product for pre-menopause (HARMONY), peri-menopause (PRO PERI), and menopause (PRO POST).
2. Vital Nutrients Professional Bone Health Collagen
Specific collagen peptides have been shown in a randomized controlled trial to improve bone mineral density and favorably shift bone turnover markers in postmenopausal women. I use it as one tool (alongside protein, calcium, vitamin D, and resistance training) for bone support. ([PMC][7])
3. XYMOGEN RelaxMax
This blend (magnesium plus calming amino acids) is commonly used to support relaxation, stress resilience, and sleep quality. These areas often wobble in perimenopause. (BONUS it also contains myo-inositol which has been shown to improve insulin sensitivity, steady blood sugar, reduce cravings, clears brain fog, balances mood, and benefits conditions like PCOS and Hashimoto’s Thyroiditis).
How to decide what’s right for you:
1. Map your top 2–3 symptoms (e.g., night sweats + insomnia).
2. Rule-outs matter: very heavy bleeding, postcoital bleeding, or new severe headaches which all deserve evaluation and investigation with your GYN/clinician.
3. Pick your “base stack”: sleep routine + resistance training + protein-forward meals.
4. Layer targeted help: for example, consider Femmenessence PRO for hot flashes and RelaxMax for relaxation and sleep.
5. Reassess every 8–12 weeks and adjust.
6. Reach out to your trusted clinician for personalized support and to discuss if the DUTCH test is right for you. I have free consultations available to start the conversation.
Perimenopause is common, dynamic, and manageable. Build your foundation, use targeted nutraceuticals to support sleep, calm mind, energy, and bone health, and add targeted medical therapy when needed. With a personalized plan and the right team, you can feel like yourself again!
Ready to get started?
To simplify trusted sourcing, you can order professional-grade products through my online dispensary Fullscript.
My favorite perimenopause nutraceuticals are located here:
Femmenessence PRO (Organic Maca) – adaptogenic support for energy, mood, and sexual wellbeing. I take it every morning. [Be sure to pick the right one for your season of life - I’m here to help if you have questions. They offer a product for pre-menopause (HARMONY), peri-menopause (PRO PERI), and menopause (PRO POST).]
Vital Nutrients Professional Bone Health Collagen – supports bone matrix & protein intake. I add it to my coffee each morning.
XYMOGEN RelaxMax – calming blend for stress and sleep support. I use every night before bed.
p.s. one thing that is consistent is that every woman’s journey is unique.
I’m available to discuss your unique journey and make personalized recommendations.
This article is educational, not medical advice, partner with your healthcare professional or contact my office for personalized care.