Five Steps to Surviving Perimenopause

Written by Amanda Tracy, ND

On August 10, 2021

The scientific explanation of perimenopause sounds so simple: a gradual slowing down of reproductive hormones until menopause. But, did you know that perimenopause can last up to 12 years and it is often called puberty in reverse!

The reality is that for many women the arrival of menopause isn’t a smooth, gliding descent but more of a turbulent landing complete with bumps, twists, and what can feel like the constant threat of a complete crash. That feeling is compounded by the timing of it, because perimenopause symptoms often begin at a particularly stressful time of life with mounting work and family demands. Add in the physical and emotional effects of hormonal fluctuations and the entire process can easily start to feel like a cruel joke. 

Thankfully it doesn’t have to be that way. 

If you’re frustrated by symptoms like mood swings, weight gain, and anxiety – start by taking a deep breath. The first step to thriving (not just surviving) perimenopause is to acknowledge that it is a natural process. Don’t beat yourself up. Now is the time to give your body – and your mind – some love. 

How to Recognize Perimenopause

It is interesting to note that some studies show our attitudes towards menopause (and aging in general) can impact how we experience perimenopause symptoms. 

Know What to Expect

Knowing what to expect and what triggers perimenopause is important. Sometimes, women are baffled by the changes and blame themselves, telling themselves that they’re not working out hard enough or not coping well with stress. That’s why a good understanding of the changes you’re undergoing is important. 

This Phase Can Last Years

Perimenopause symptoms typically begin in the mid-forties however, I have seen many women in my practice in the midst of perimenopause hormone changes in their late 30s. Perimenopause continues for a number of years until full menopause is reached, which is defined as having gone a full year without a menstrual period. Over this period, the ovaries’ hormonal production slows down in fits and starts, leading to fluctuating levels of estrogen, which creates shifting imbalances in the delicate seesaw of estrogen and progesterone (hence, feeling like you’re in puberty again). 

Signs You May Be in Perimenopause

Symptoms can be subtle at first and easily mistaken for something else. They may increase gradually or you may find they come and go along with your fluctuating hormones, they can include:

  • Changes in menstruation, which could include changes in timing (both more frequent or less frequent) and periods that are suddenly much heavier 
  • Unexplained weight gain, particularly around the midsection
  • Depression
  • Brain fog
  • Hot flashes
  • Tender breasts
  • Anxiety and panic attacks
  • Restless legs
  • Insomnia and difficulty staying asleep
  • Irritability
  • Changes in libido
  • Vaginal dryness
  • Acne (as if wrinkles and chin hairs weren’t enough to worry about!)

5 Ways to Find Balance During Perimenopause


The good news is that several lifestyle changes, along with more specific strategies tailored to your unique needs by a Naturopathic Doctor like me, can help maintain hormonal balance and make it easier to cope with the changes that do occur. 

1 – Aim for a Good Night’s Sleep

Ironically, getting restful sleep can become more challenging just when we need it most, and a majority of perimenopausal women report sleep difficulties. Waking up frequently is the most common complaint, often due to hot flashes. 

Strengthen Your Bedtime Routine:

  • Avoid using electronic devices at least one hour before bedtime. Turn on the blue light filter or wear blue light blocking glasses after sunset.
  • Avoid caffeine after noon (sorry fellow chocaholics, but this includes dark chocolate in addition to coffee and tea). 
  • Avoid large meals after 3pm and if you must exercise in the evening, choose a less vigorous form (i.e. walking, yin or hatha yoga, stretching).
  • Build a predictable wind-down routine into your evenings. 
  • Keep your bedroom temperature on the cooler side for better sleep.
  • Avoid synthetic materials in bedding and sleepwear in favor of natural fabrics like cotton, bamboo or linen. Two of my favorite sleepwear companies are Pact for organic cotton underwear and loungewear as well as PJs and Faceplant Dreams for silky bamboo PJs.*

2 – Address Your Stress

The stress hormone cortisol rises with age, which is partly to blame for the increase in belly fat many women experience during perimenopause. Taking proactive steps to reduce stress will help get a handle on cortisol levels. 

Find Out What Works Best for You

Adequate sleep helps to lower cortisol, as does gentle, mindful activity such as yoga or tai chi. In fact, studies have found that mindful activities can reduce hot flashes, which will favorably impact sleep, which in turn helps to reduce belly fat – it’s all connected!

3 – Get Moving

Regular exercise helps with stress, reduces body fat, and improves your overall quality of life. It’s important to acknowledge, however, that the types of exercise that worked in your 20s and 30s may not be as effective at this stage of life. 

Consider Reducing the Intensity

Somewhat ironically, overly intense exercise can overtax your body and result in an increase in cortisol. Remember those stress tips above? That’s why it’s important to find a form of exercise that works for you. Don’t feel pressure to do high-intensity workouts if your body responds better to lower-intensity programs like Pilates or walking. Because everybody is different, it may take a bit of trial and error to find what works for you. The best exercise is always the one that you will stick to, and the one that gives you joy instead of adding to your stress levels. Spending time in nature has also proven to lower cortisol. Think of ways you can combine your movement with nature – a walk on the beach, hiking, cycling on a wooded bike path, yoga in your back yard…

4 – Eat a Hormone-Supportive Diet

The concept of being gentle with your body during perimenopause extends to your diet. At this stage in life, you should focus on foods that support hormonal balance and provide nourishment. The four pillars of a healthy perimenopause diet are:


You start to lose muscle with age, so it’s important to counteract that adequate protein to retain muscle mass. Choose plant-based sources like chickpeas, black beans, split peas and lentils. 


A slowed metabolism may also slow down digestion. This may lead to constipation and foods hanging around longer causing fermentation = gas and bloating. Fiber helps food move smoothly through the bowels and also helps us feel fuller for longer, limiting cravings. Fiber can be found in loads of foods from flaxseed, chia seed, beans and legumes to spinach, broccoli, apples and pears.


Healthy fats, like Omega-3 fatty acids, can help reduce hot flashes and may boost mood, according to some studies. Good sources of Omega-3 include walnuts, hemp seeds and flax seeds.

For meal ideas and quick recipes, download my Grocery Guide for Hormone Health

5 – Manage your Blood Sugar and Insulin Levels

High blood sugar can exacerbate hot flashes and other perimenopausal symptoms. This can be a bit of a vicious cycle, because changing hormonal levels can actually raise the production of the hormone insulin, which regulates blood sugar. It’s crucial to limit consumption of processed carbohydrates and sweet drinks during perimenopause, as insulin resistance becomes more commonplace. Fiber and protein can help preserve insulin sensitivity, so instead of a quick hit of something sweet for a snack, look for more satiating foods like nuts or whole grains. 

My “go to” afternoon snacks:

  • an apple or pear with nut butter from Big Spoon Roasters
  • ¼ cup almonds or walnuts with a few dried cherries, goji berries or golden berries
  • Trader Joe’s Seeds & Grains Crispbread topped with either ¼ avocado or a smear of hummus topped with a slice of tomato

A lot is happening during perimenopause for many women – career, family, decisions about the future – but taking some time to focus on your own health will help you feel empowered with the changes in your body.

If you are looking for extra support or experiencing hormonal issues and would like to dive deeper into what’s going on and the best natural course of action give me a call. As your Naturopathic Doctor, I can help guide you in this transition in a healthy and holistic way.

Book your appointment today to get started! New patients can book a FREE Meet & Greet with me HERE and existing patients can book a consultation with me HERE.

*I have not been financially, or otherwise, compensated by the companies or products mentioned in this article. I strive to give you the most actionable, helpful and specific advice possible and often, that leads me to recommend specific brands.


Download My Grocery Guide for Hormone Health ⤵

Balance your Hormones with Food and Feel Like Yourself Again

My Grocery Guide for Hormone Health will help you:

  • Stop feeling bloated after meals
  • Prevent unnecessary weight gain
  • Avoid the confusion about what to eat and
  • Streamline your grocery shopping to save you time, energy and money!


  • The best foods to manage your hormones
  • The easiest ways to add these foods into your diet right now
  • Quick and Simple Recipes that anyone can do – no experience or fancy equipment necessary

You May Also Like…


Submit a Comment

Your email address will not be published. Required fields are marked *