Five Steps to Surviving Perimenopause

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.

Is Stress Sabotaging your Hormones?

Here’s what to do about it…

The pandemic has brought us over a year of stress, anxiety, and fear of the unknown. This Fall things are ramping up again, with increased COVID infection rates due to the delta variant and back to school worries. Hundreds of studies have been published on the negative health effects of the pandemic worldwide, and what tops the list? Skyrocketing levels of stress and anxiety. 

Whether you’re stressed about contracting COVID-19 or dealing with the many “pivots” brought on by recurring lockdowns and decreased socialization, such high stress levels are simply not sustainable and can create constant disruptions in your hormone balance. Now is the time to work on demystifying stress and anxiety so that you can disarm it and reclaim your inner peace this fall.

Stress, Decoded 

Stress and anxiety have deep roots in the body, involving your brain, gut, hormones and nervous system. Let’s see what science has to say about it:

Fight or Flight Mode, aka the HPA Axis

When a stressor hits, your body goes into emergency mode by activating the Hypothalamic Pituitary Adrenal (HPA) Axis. The adrenal glands receive the ‘danger’ message from the hypothalamus and pituitary glands in the brain, triggering them to produce adrenaline which then spurs your entire body into action to either fight or flee from the situation. 

The problem? A system that was designed to be used for just a few minutes at a time also has the ability to be active most of the time. This means that chronic stress forces your adrenals to work overtime. Becoming stuck in “fight or flight mode” due to constant stress leads to overwhelm and, inevitably, exhaustion. 

The second problem with being stuck in “fight or flight” mode is that your adrenal glands are shifted away from “rest and restore” mode and this is the mode in which your adrenals support hormone balance – providing the building blocks for estrogen and progesterone – a key feature of the adrenals glands that comes into play during perimenopause.

Your Microbiome Affects Your Stress Levels

Your microbiome is made up of the diverse community of microbes that reside in your gut. What many people ignore when discussing the microbiome is the fact that it is not only involved in digestion – in fact, gut bacteria are also strongly linked to your brain. 

A 2019 study looking at the effects of a Mediterranean diet high in fresh fruit, vegetables, healthy fats, polyphenols (i.e. dark chocolate and berries) and fermented foods (i.e. kimchi or sauerkraut) helped participants to be more stress resilient. Researchers noted the role of the microbiota in producing serotonin (the ‘feel good hormone). This role is important to note because many women in perimenopause are experiencing lower progesterone levels and lower progesterone levels decrease serotonin.

Another 2019 study showed that both probiotics and prebiotics increase our ability to handle stress by supporting gut microbes, and can actually reverse some of the negative effects of stress.  

Many studies have shown that stress changes our microbiome, which further reduces our ability to handle stress. A 2017 study concluded that even short-term stress exposure (especially in early life) reduces microbiome diversity and increases anxiety. 

How to Balance, Manage and Reduce Anxiety

You can’t control what life throws at you, but you can control how you respond to it. Here are our top tips to help you cope with anxiety both in the moment, and build long term stress resilience.

1 – Breathing Exercises

Do you experience panic attacks? Deep breathing can help reduce panic and overwhelm in the moment, and help you cope in the long term. Try these two exercises, backed by scientific research.

Deep Breathing for Vagal Nerve Tone

The vagus nerve is the main line of communication between your gut and your brain. Certain breathing exercises can improve vagal nerve tone to get you out of “flight or flight” and into”rest and digest” mode. 

A 2018 study reported decreased stress and anxiety, and increased sense of well-being after doing breathing exercises. Effective techniques include slow breathing, longer exhales than inhales and breathing from the diaphragm. Learn how in this short video!

Alternate Nostril Breathing

This ancient practice has been used in yoga for centuries. Recent research suggests that this technique can bring the mind and body to a state of balanced calm, and reduce both stress and anxiety. 

Learn this technique in this short video!

2 – Smartphone Apps

Is constant social media scrolling making you more anxious? How can you harness the power of technology to reduce feelings of overwhelm and anxiety? These 3 apps use evidence-based scientific research. 


MindshiftTM uses evidence-based Cognitive Behavioral Therapy techniques to help you manage feelings of stress, anxiety, worry and panic. When a stressor hits, try features like Coping Cards and the Chill Zone to ground yourself and cope in the moment. Features like the Thought Journal, Goal Setting and Expanding Your Comfort Zone will help shift your mindset to make positive change that lasts.


Have you tried to meditate without success? Headspace features hundreds of guided meditation sessions for beginners. Choose a topic (like anxiety or sleep) and the app will suggest the best sessions for you. From bite-sized mini meditations to more in-depth sessions, the app will help train your mind so you can gain solid benefits from your meditation practice.


Muse goes one step further by pairing a brain-sensing headband with an app to give you real-time feedback on your brain activity during meditation and sleep. Mind wandering during meditation? Stormy weather sounds will cue you to refocus. Peaceful weather sounds confirm you’re in the calm zone. 

3 – Nutritional & Herbal Supplements


This amino acid found in green tea is well known for its ability to reduce stress and anxiety. By interacting with both dopamine and GABA receptors in the brain, it brings a sense of calm and well-being without feeling drowsy or “drugged”. If green tea isn’t for you, supplementing with L-Theanine means you get all the stress-busting benefits with none of the jittery caffeine drawbacks. A 2019 study of stressed, healthy adults showed that just one month of supplementation with L-Theanine significantly reduced anxiety and stress, and improved cognitive function. 


This herb has been used for 3,000 years in Indian Ayurvedic Medicine as a whole-body tonic. Classed as an adaptogen, Ashwagandha supports your adrenal glands and HPA axis to help you stay calm and resilient in the face of stress. A 2019 study of healthy, anxious adults showed that ashwagandha supplementation significantly reduced anxiety and improved mood. 

Are you ready to face whatever this Fall has in store for you, anxiety-free? Let’s meet to discuss and assess your current stress and anxiety levels. Together, we can come up with a solid treatment plan including supplements, diet and lifestyle strategies to dial back anxiety and increase your stress resilience. Isn’t it time you focused on yourself? 

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


Adan RAH, van der Beek EM, Buitelaar JK, et al. Nutritional psychiatry: Towards improving mental health by what you eat. Eur Neuropsychopharmacol. 2019;29(12):1321-1332. doi: 10.1016/j.euroneuro.2019.10.011

Alternate Nostril Breathing. Lotus Flower Yoga. Accessed on September 18, 2020.

Anxiety Canada. MindshiftTM CBT App. Accessed on September 18, 2020.

Anxiety Canada. How to Tolerate Uncertainty. Accessed on September 18, 2020.

Bharwani A, Mian MF, Foster JA, Surette MG, Bienenstock J, Forsythe P. Structural & functional consequences of chronic psychosocial stress on the microbiome & host. Psychoneuroendocrinology. 2016; 63:217-227. doi: 10.1016/j.psyneuen.2015.10.001

Burokas A, Arboleya S, Moloney RD, et al. Targeting the Microbiota-Gut-Brain Axis: Prebiotics Have Anxiolytic and Antidepressant-like Effects and Reverse the Impact of Chronic Stress in Mice. Biol Psychiatry. 2017;82(7):472-487. doi: 10.1016/j.biopsych.2016.12.031

Firth J, Gangwisch JE, Borisini A, Wootton RE, Mayer EA. Food and mood: how do diet and nutrition affect mental wellbeing?. BMJ. 2020;369:m2382. Published 2020 Jun 29. doi:10.1136/bmj.m2382

Foster JA, Rinaman L, Cryan JF. Stress & the gut-brain axis: Regulation by the microbiome. Neurobiol Stress. 2017; 7:124-136. Published 2017 Mar 19. doi: 10.1016/j.ynstr.2017.03.001

Gerritsen RJS, Band GPH. Breath of Life: The Respiratory Vagal Stimulation Model of Contemplative Activity. Front Hum Neurosci. 2018; 12:397. Published 2018 Oct 9. doi:10.3389/fnhum.2018.00397

Headspace. Accessed September 18, 2020.

Hidese S, Ogawa S, Ota M, et al. Effects of L-Theanine Administration on Stress-Related Symptoms and Cognitive Functions in Healthy Adults: A Randomized Controlled Trial. Nutrients. 2019;11(10):2362. Published 2019 Oct 3. doi:10.3390/nu11102362

Kamath A, Urval RP, Shenoy AK. Effect of Alternate Nostril Breathing Exercise on Experimentally Induced Anxiety in Healthy Volunteers Using the Simulated Public Speaking Model: A Randomized Controlled Pilot Study. Biomed Res Int. 2017; 2017:2450670. doi:10.1155/2017/2450670

Lopresti AL, Smith SJ, Malvi H, Kodgule R. An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract: A randomized, double-blind, placebo-controlled study. Medicine (Baltimore). 2019;98(37): e17186. doi:10.1097/MD.0000000000017186

Muse. Accessed September 18, 2020.

Pratte MA, Nanavati KB, Young V, Morley CP. An alternative treatment for anxiety: a systematic review of human trial results reported for the Ayurvedic herb ashwagandha (Withania somnifera). J Altern Complement Med. 2014;20(12):901-908. doi:10.1089/acm.2014.0177

Telles S, Gupta RK, Yadav A, Pathak S, Balkrishna A. Hemisphere specific EEG related to alternate nostril yoga breathing. BMC Res Notes. 2017;10(1):306. Published 2017 Jul 24. doi:10.1186/s13104-017-2625-6

Thomaz F S Bastiaanssen, Caitlin S M Cowan, Marcus J Claesson, Timothy G Dinan, John F Cryan, Making Sense of … the Microbiome in Psychiatry, International Journal of Neuropsychopharmacology, Volume 22, Issue 1, January 2019, Pages 37–52,

Vagus Nerve: Breathing for Relaxation. Tune Up Fitness. Accessed on September 18, 2020.

White DJ, de Klerk S, Woods W, Gondalia S, Noonan C, Scholey AB. Anti-Stress, Behavioural and Magnetoencephalography Effects of an L-Theanine-Based Nutrient Drink: A Randomised, Double-Blind, Placebo-Controlled, Crossover Trial. Nutrients. 2016;8(1):53. doi:10.3390/nu8010053

Yoto A, Motoki M, Murao S, Yokogoshi H. Effects of L-theanine or caffeine intake on changes in blood pressure under physical and psychological stresses. J Physiol Anthropol. 2012;31(1):28. doi:10.1186/1880-6805-31-28

Alternate Nostril Breathing technique video