Perimenopause is rough on many women. Menopause too. As a woman, one’s sense of equanimity can feel under attack starting in your forties, sometimes earlier. As your ovaries start to run out of ripe eggs, progesterone drops, and it’s harder to soothe yourself. Cravings increase. Many women, myself included, feel less stress resilient. Then there’s the issue of thyropause, the decline in thyroid function that commonly hits in early mid-life, which starts sometime in the forties. Symptoms include weight gain, fatigue, cranky mood, dry hair and skin, maybe hair loss.
In addition to the body’s internal factors like declining egg supply, there are external factors that make perimenopause and menopause difficult to navigate. The biggest factors? First, our fast-paced, digital culture drives us to live more ON more than OFF. Second, toxins are overloading and assaulting our delicate endocrine system. Third, our broken healthcare system treats conditions with the latest pharmaceuticals rather than assessing root cause. Commonly I see a patient prescribed an antidepressant and maybe a sleeping pill for high cortisol instead of having her hormones checked. With this approach, it’s no surprise that hormone imbalances are on the rise and so many of us are suffering from hormonal chaos.
In my experience, that’s particularly evident in the ten years before your final menstrual period, perimenopause, and for years after, in menopause. When you understand the factors, you’ll see how natural solutions can rebalance your hormones—and your sanity.
What’s Happening with Hormones at Perimenopause + Menopause
When you don’t have enough progesterone, life feels difficult. For most women, this begins around age 35 to 40, or as late as 45. Here are common symptoms.
- Irregular menstrual cycles, or cycles becoming more frequent as you age
- Agitation or premenstrual syndrome (PMS)
- Painful and/or swollen breasts (mastalgia)
- Cyclical headaches (particularly menstrual or hormonal migraines)
- Your blood seems to pool easily, or your skin bruises easily
- Hemorrhoids or varicose veins
- Heavy or painful periods (heavy: going through a super pad or tampon every two hours or less; painful: you can’t function without ibuprofen)
- Bloating, particularly in the ankles and belly, and/or fluid retention (in other words, you gain 3 to 5 pounds or more before your period)
- Ovarian cysts, breast cysts, or endometrial cysts (polyps)
- Easily disrupted sleep, perhaps with night sweats
- Itchy or restless legs, especially at night
- Increased clumsiness or poor coordination
- More cravings for food, alcohol, anything to calm you down
- Miscarriage, usually in the first trimester
- Infertility or subfertility
When your progesterone is lower than it was five or ten years ago, you feel more stressed. It’s tough to relax. In short, you may feel hyperaroused, which is not a good thing.
Hyperarousal results from the disruption of specific hormones—including progesterone, cortisol, and even insulin—leading to poor food choices, sleep debt, and mood problems. As you know, cortisol is the main stress hormone. It also governs digestion, cravings, sleep/wake patterns, blood pressure, and physical activity. When cortisol is too high for you, certain bad habits can set in: you overeat, you drink coffee, you can’t sleep, weight rises. Over time, cortisol keeps going up, blood sugar spikes, and then you desperately need a glass of wine to unwind at night—it’s a vicious cycle that begets higher cortisol, lower progesterone, higher insulin.
As a woman gets older and enters the second phase of perimenopause, both progesterone and estrogen (specifically, estradiol) are lower. Testosterone drops too, leading to less muscle mass (dropping five pounds of muscle per decade) and rising fat mass, a dreaded combination that accelerates aging, as covered in my book, Younger. Low estrogen may cause mood and libido to tank and makes the vagina less moist, joints less flexible, and mental state less focused and alive. Low testosterone may cause fatigue, disrupted sleep, decreased libido, and weight gain. This hormonal roller coaster has major metabolic consequences and costs to your healthspan.
We are also exposed to more toxins than ever before. Endocrine disruptors are synthetic chemicals that are now rampant in plastic materials, cosmetics, cleaning supplies, and other products we use on a day-to-day basis. Endocrine disruptors interfere with the production, transportation, and metabolism of most hormones. And since these environmental toxins are almost impossible to avoid, they may be wreaking havoc on your body without your awareness. The problem is these chemicals, aptly called obesogens, have the potential to make us sick and fat.
Get this: as our exposure to endocrine disruptors has increased, so has the incidence of thyroid disease in the United States, particularly for thyroid cancer and thyroid autoimmune disease. People who showed the highest 20 percent of exposure to environmental toxins also experienced up to 10 percent more thyroid function impairment than those with the lowest 20 percent exposure. The most common exposure to thyroid disruptors is via flame retardants. Sound strange? Guess where the worst offenders are—your home and office furniture.
A How-To Guide, Based on the Best Science
With age, women face a slew of challenges that become more pressing in perimenopause and menopause. Eighty-five percent of Western women experience hot flashes, night sweats, and mood swings.
It probably sounds pointless to try to do anything about it, besides a prescription med to keep your emotional state somewhat stable. Although conventional healthcare simply tells women, “This is just part of aging,” it’s not true. Your hormones are not doomed to perpetual imbalance. Natural solutions can put your hormones back in check, along with your energy, emotional stability, and willpower.
Solutions for Perimenopause
For women who are still cycling, I often recommend chasteberry to raise progesterone levels. It’s been shown in multiple randomized trials to lessen premenstrual syndrome, premenstrual dysphoric disorder, improve fertility, reduce cyclic breast pain, and regulate menstrual cycles. Chasteberry is thought to increase the release of luteinizing hormone from the pituitary, which nudges the ovary to release more progesterone—so if you’re not ovulating, it’s far less likely to work.
- Chasteberry. Also known by several other terms, including chaste tree, chaste tree berry, and vitex, this herb is available as capsules or liquid tincture, and the average dose is 500 to 1,000 mg/day. It is proven to reduce PMS and infertility, ultimately by raising progesterone.
The combination of chasteberry together with St. John’s wort is very effective at improving mood in perimenopause. Researchers found that the combination of herbs was more effective than placebo for perimenopause-related PMS symptoms, particularly anxiety. We already know that St. John’s wort is superior to placebo for depression, based on a review of twenty-three randomized trials of 1,757 patients. St. John’s wort even improves PMS on its own. Additionally St. John’s wort reduces hot flashes and increases sexual satisfaction in women.
- St. John’s wort. This botanical improves PMS on it’s own, but is especially effective in perimenopause when combined with chasteberry. Dose 300 mg three times per day.
Let’s address the biggest concern of perimenopause: weight. When it comes to weight loss, or preventing weight gain, in perimenopausal women, the issue is blood sugar and keeping insulin levels in the optimal zone. Whether women are at a healthy weight or overweight, blood sugar rises with age. Maintaining a balanced diet made up of mostly vegetables and clean proteins may prevent women from gaining fat.
- Berberine, a supplement that cools inflammation, does many things that can help in perimenopause, including: lowers cholesterol, normalizes serum glucose, and assists with weight loss because it behaves like an antioxidant. I recommend it to patients when their fasting blood sugar is greater than 85 mg/dL. Take 300 to 500 milligrams once to three times per day, which has been shown to activate an important enzyme called adenosine monophosphate-activated protein kinase, or AMP, nicknamed “metabolic master switch.” Who doesn’t like the sound of that?
- Intermittent fasting. Since aging can also throw off insulin levels and tip the scales, one of the best ways to correct insulin is with intermittent fasting. I recommend a 16/8 protocol: sixteen hours of overnight fast followed by an eight-hour eating window. Women with thyroid or adrenal issues may need a slow onramp, starting first with twelve- to fourteen-hour fasts twice per week. The problem with intermittent fasting is that many women know about it, but don’t know how to perform it correctly for the female body. Learn more about metabolic health and the role intermittent fasting can play in regulating insulin in my book WOMEN, FOOD, AND HORMONES.
- Alpha lipoic acid (ALA), a powerful antioxidant that occurs naturally in mitochondria, can also reset your blood sugar. ALA prevents cell damage and repairs damaged cells. It’s one of the most critical anti-aging, anti-inflammatory, and antioxidant agents you can ingest. When applied as a serum, ALA (5 percent) reduces aging in the face over twelve weeks. ALA is 400 times stronger than vitamins C and E. The recommended dosage is somewhere between 300 to 1,800 mg per day for it to act like a free radical scavenger. ALA may protect bones as you age and keeps your cells sensitive to insulin so that your blood sugar doesn’t climb. One study in obese women showed that ALA aided weight loss when they were on an energy-restricted diet. Other studies found a benefit at 800 mg/day for weight loss, but yet another study confirmed that 1,800 mg is superior to 1,200 mg for weight loss in women and men.
Solutions for Menopause
Now, about those symptoms of menopause… here are some of my favorite medically-proven natural remedies.
- Paced breathing cuts flashes by 44 percent. Not too shabby. Breathe deeply twenty minutes twice per day with a five-second inhale, a ten-second hold, and a five-second exhale.
- Maca. This powerful herb helps with a variety of issues associated with hormonal imbalance, such as menstrual irregularities, fertility, menopause symptoms, and impotence. It increases estradiol in menopausal women and helps with insomnia, depression, memory, concentration, energy, hot flashes, and vaginal dryness, as well as improved body mass index and bone density. A powerhouse, maca extract comes in both a capsule and a liquid tincture available at your local health food store. The common dose is 2,000 mg/day. Maca has a malty taste that I prefer to mask with 1 to 2 tablespoons of raw cocoa powder in my breakfast smoothies.
- Acupuncture. I’m a fan of outsourcing your neuroendocrine repair, at least in part. Acupuncture has been shown to reduce hot flashes and night sweats.
As always, speak with an integrative practitioner or functional medicine clinician before adding any supplements to your routine. Check that the supplement won’t interfere with any medications you’re currently taking.
When facing hormonal imbalances, you aren’t destined to suffer. Certainly, you don’t have to resort to taking synthetic drugs that you don’t need. Knowledge is power. The best way to proceed is to take care of your progesterone, cortisol, and insulin so they take care of you. It’s entirely possible to tame the chaotic hormones of perimenopause naturally and to ease into menopause with a sense of balance and grace.
- For more science-backed tips on reaching balance without synthetic hormones, read The Hormone Cure.
- If you want a deeper dive into perimenopause, menopause, and when to use bioidentical hormones, check out this video that I recorded recently with Gwyneth Paltrow along with an comprehensive Q&A.
 Kavlock, R., et al. “Research needs for the risk assessment of health and environmental effects of endocrine disruptors: A report of the US EPA-sponsored workshop.” Environmental Health Perspectives 104, no. 4 (1996); Melnick, R., et al. “Summary of the National Toxicology Program’s Report of the Endocrine Disruptors Low-Dose Peer Review.” Environmental Health Perspectives 110, no. 4 (2002): 427; Patrick, L. “Thyroid disruption: Mechanisms and clinical implications in human health.” Alternative Medicine Review 14, no. 4 (2009).
 Freeman E. W., et al. “Prevalence of hot flushes and night sweats around the world: A systematic review.” Climacteric 10, no. 3 (2007): 197-214.
 Berger, D., et al. “Efficacy of Vitex agnus castus L. extract Ze 440 in patients with pre-menstrual syndrome (PMS).” Archives of Gynecology and Obstetrics 264, no. 3 (2000): 150-153; Loch, E. G., et al. “Treatment of premenstrual syndrome with a phytopharmaceutical formulation containing Vitex agnus castus.” Journal of Women’s Health & Gender-Based Medicine 9, no. 3 (2000): 315-320; Schellenberg, R. “Treatment for the premenstrual syndrome with agnus castus fruit extract: Prospective, randomised, placebo controlled study.” BMJ 322, no. 7279 (2001): 134-137; Atmaca, M., et al. “Fluoxetine versus Vitex agnus castus extract in the treatment of premenstrual dysphoric disorder.” Human Psychopharmacology: Clinical and Experimental 18, no. 3 (2003): 191-195; Prilepskaya, V. N., et al. “Vitex agnus castus: Successful treatment of moderate to severe premenstrual syndrome.” Maturitas 55 (2006): S55-S63; Westphal, L. M., et al. “Double-blind, placebo-controlled study of Fertilityblend: A nutritional supplement for improving fertility in women.” Clinical and Experimental Obstetrics & Gynecology 33, no. 4 (2006): 205-208; Dietz, B. M., et al. “Botanicals and their bioactive phytochemicals for women’s health.” Pharmacological Reviews 68, no. 4 (2016): 1026-1073; Mirghafourvand, M., et al. “Effects of Vitex agnus and flaxseed on cyclic mastalgia: A randomized controlled trial.” Complementary Therapies in Medicine 24 (2016): 90-95; Cerqueira, R. O., et al. “Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: A systematic review.” Archives of Women’s Mental Health 20, no. 6 (2017): 713-719; Rafieian-Kopaei, M., et al. “Systematic review of premenstrual, postmenstrual and infertility disorders of Vitex agnus castus.” Electronic Physician 9, no. 1 (2017): 3685; di Scalea, T. L., et al. “Premenstrual dysphoric disorder.” Psychiatric Clinics 40, no. 2 (2017): 201-216; Verkaik, S., et al. “The treatment of premenstrual syndrome with preparations of Vitex agnus castus: A systematic review and meta-analysis.” American Journal of Obstetrics & Gynecology 217, no. 2 (2017): 150-166.
 van Die, M. D., et al. “Effects of a combination of Hypericum perforatum and Vitex agnus-castus on PMS-like symptoms in late-perimenopausal women: Findings from a subpopulation analysis.” The Journal of Alternative and Complementary Medicine 15, no. 9 (2009): 1045-1048.
 Linde, K., et al. “St. John’s Wort for depression—an overview and meta-analysis of randomised clinical trials.” BMJ 313, no. 7052 (1996): 253-258.
 Canning, S., et al. “The efficacy of Hypericum perforatum (St. John’s Wort) for the treatment of premenstrual syndrome.” CNS Drugs 24, no. 3 (2010): 207-225.
 Grube, B., et al. “St. John’s Wort extract: Efficacy for postmenopausal women probably by menopausal symptoms of psychological origin.” Advances in Therapy 16 (4) (1999): 177–86; Abdali, K., et al. “Effect of St. John’s Wort on severity, frequency, and duration of hot flashes in premenopausal, perimenopausal and postmenopausal women: A randomized, double-blind, placebo-controlled study.” Menopause 17, no. 2 (2010): 326–331.
 Maczurek, A., et al. “Lipoic acid as an anti-inflammatory and neuroprotective treatment for Alzheimer’s disease.” Advanced Drug Delivery Reviews 60, no. 13 (2008): 1463–1470; Koh, E. H., et al. “Effects of alpha-lipoic acid on body weight in obese subjects.” American Journal of Medicine 124, no. 1 (2011): 85-e1; Roberts, J. L., et al. “Emerging role of alpha-lipoic acid in the prevention and treatment of bone loss.” Nutrition Reviews 73, no. 2 (2015): 116–125.
 Meissner, H. O., et al. “Use of gelatinized Maca (lepidium peruvianum) in early postmenopausal women.” International Journal of Biomedical Science: IJBS 1, no. 1 (2005): 33-45; Meissner, H. O., et al. “Hormone-balancing effect of pre-gelatinized organic Maca (Lepidium peruvianum Chacon): (III) Clinical responses of early-postmenopausal women to Maca in double blind, randomized, placebo-controlled, crossover configuration, outpatient study.” International Journal of Biomedical Science: IJBS 2, no. 4 (2006): 375-394; Brooks, N. A., et al. “Beneficial effects of Lepidium meyenii (Maca) on psychological symptoms and measures of sexual dysfunction in postmenopausal women are not related to estrogen or androgen content.” Menopause 15, no. 6 (2008): 1157-1162; Dording, C. M., et al. “A double‐blind, randomized, pilot dose‐finding study of Maca root (L. Meyenii) for the management of SSRI‐induced sexual dysfunction.” CNS Neuroscience & Therapeutics 14, no. 3 (2008): 182-191.