How to Ease Symptoms of Perimenopause, according to an Integrative Dietitian

Written by: Esther Blum, MS, RD, CDN, CNS


Published on: October 13, 2022


Reviewed by: Denise John, PhD


Menopause is known for its infamous symptoms, which we’ll discuss soon, but it’s medically defined by your menstrual cycle. When you have a full year without a period, that’s when you’re in menopause—despite what other symptoms you are (or are not) having.

If you’re having all the symptoms of menopause but still having periods, you’re technically in perimenopause, which is a period of time before menopause that can last for 5 to 10 years. (It must be 12 consecutive months without a period to be considered menopause: If you haven’t had a period in 4 months but you get a sudden surprise period, the 12-month countdown to menopause resets to 0.)

Symptoms of menopause can begin long before you’re in menopause—the average age of menopause is 51, but you can have symptoms in your 40s. Some women go through early menopause and begin having symptoms in their late 20s or 30s. I wrote my latest book, See Ya Later, Ovulator!: Mastering Menopause with Nutrition, Hormones, and Self-Advocacy, as a full guide to this transition—and I’ll break down the basics here.

What Causes Symptoms?

During perimenopause, the supply of eggs in a woman’s ovaries diminishes and ovulation becomes irregular. The traditional changes we think of as menopause happen when your ovaries no longer produce high levels of hormones and stop releasing eggs into the fallopian tubes.

Throughout this time, estrogen levels can fluctuate up to 30 percent on any given day. And progesterone levels steadily drop—especially if high amounts of daily stress are part of the picture, which can lower progesterone levels even further. So women in perimenopause and menopause can be relatively estrogen dominant, which means their amounts of progesterone relative to estrogen are low, and this causes many symptoms.

Also, if your detox pathways are suboptimal due to genetics or poor liver or gut function, your body could have a difficult time removing excess estrogen from the body, and this contributes to a relative estrogen dominance, too.

Perimenopause and Menopause Symptoms

You can help smooth the process into menopause by beginning to address the symptoms during perimenopause, which requires optimizing the balance of estrogen, progesterone, and testosterone. It starts with diet and lifestyle, but adding in hormone replacement therapy (HRT) can significantly help. Here are some ways to reduce the intensity of the most common symptoms. Many times, when you address one symptom, it can help with the others. (As always, talk to your doctor about what’s right for you.)



Changes in your menstrual cycle leading up to menopause can show up as heavier periods and clots. Typically you have a couple of surge days, where you bleed through a super tampon or pad every hour or you can’t go through the night without changing a tampon or pad. But for some women, the opposite is true: Their periods get lighter and lighter and gently fade away. You can also begin to skip or miss periods. Changes in your diet may help with irregular periods.


  1. Increase protein intake. In general, you want to optimize your protein intake during this time. In addition to many other physiological function, our bodies need protein to produce hormones. As testosterone, progesterone, and estrogen are decreasing, it’s important to give the body the protein it needs to maintain all of our bodily functions, including protein production.

  2. Eat at least one gram per pound per day of your ideal body weight. For those who don’t want to do the math, you can estimate at least four to six ounces of protein at every meal.

  3. It’s also important that you maintain an even protein distribution intake throughout the day. For example, if you typically eat one egg at breakfast, a three-ounce can of tuna at lunch, and then a six-ounce steak at dinner, consider increasing your protein intake in the earlier meals to match the later ones.

  4. Eat cruciferous vegetables. You can help your liver detox by eating a lot of cruciferous vegetables in the brassica family: broccoli, cauliflower, Brussels sprouts, radishes, kale—all of these are beneficial to include in the diet. The fiber may help remove excess estrogen from the body through bowel movements.

  5. Eat organic foods. Reducing the amounts of toxic chemicals and hormones that you ingest by eating organic foods and grass-fed meats can ease the burden on your liver as it detoxes excess estrogen.

  6. Limit dairy. Some women find that when they eliminate dairy from their diet, their periods become much lighter.

  7. Limit caffeine and alcohol. It’s never easy to deliver this news, but I’ve found that removing or limiting caffeine and alcohol, as hard as it may be, can help lighten heavy periods.

  8. Take B vitamins. Supplementing with B vitamins can help your liver detox, support your energy throughout the day, and, in my experience, may improve heavy periods.

  9. Try chaste tree. Chaste tree is an herb that can help boost the production of progesterone to balance estrogen levels, which can relieve heavy periods. It’s available over the counter as vitex.



Most of us are familiar with hot flashes—the sudden rush of heat and sweat that comes seemingly out of nowhere.


  1. Consider a keto or paleo diet. Hot flashes can be triggered by blood sugar imbalances. For some women, keto or paleo diets can help balance blood sugar levels and reduce the severity and number of hot flashes. Sustaining a keto diet for longer than three months can affect the normal function of the thyroid and adrenal glands, so a paleo-style diet may be a better alternative during menopause.

  2. Limit caffeine, alcohol, and excess sugar. These can trigger hot flashes, so reducing or eliminating them helps.

  3. Keep your home cool. Keeping the room temperature cool during the day can ease the discomfort of hot flashes. At night, sleeping in a cool room, using a cooling mat, and wearing minimal clothing to bed can make a huge difference.



Lack of natural lubrication in the vagina can cause sex to be painful, which can contribute to low libido (as well as low testosterone levels).


  1. Fat is naturally lubricating. Eating plenty of healthy omega-3 fats during menopause and perimenopause—cold-water fatty fish like salmon, herring, sardines, mackerel are great sources—is great for your overall health and may help with lubrication. Supplementing with fish and primrose oils and avoiding inflammatory foods can also help you get more omega-3s.



The decline in estrogen and progesterone can bring on insomnia.


  1. Limit caffeine and alcohol. Caffeine and alcohol both affect sleep, so if you’re experiencing insomnia, you’ll want to consider minimizing or eliminating these from your diet.

  2. Most people think they’re going to be exhausted when they stop drinking coffee but find that their energy levels increase and cortisol levels decrease, and that they sleep much better at night. It can be a profound change for many women. You can drink coffee alternatives, like Four Sigmatic, that can give your brain a little boost in mental focus without the side effects of caffeine. If you continue to drink coffee, be mindful of how it’s affecting your sleep, and do not go above eight ounces per day (typically a “cup” for most people is 12 to 16 ounces, which is really about two cups).

  3. Alcohol competes with regular detoxification of the body. Your liver detoxes your hormones at night, but if alcohol is present, it will prioritize alcohol first, creating an imbalance of circulating hormones.

  4. Drink chamomile tea. Brewing one to three bags of chamomile tea at night is a good way to calm down at the end of the day and help you get deeper sleep.

  5. Limit screen time. Blue light can lower the production of melatonin, so eliminating screen time an hour or so before bed can help with sleep.

  6. Ease your mind. As little as 10 minutes of meditation can lower your cortisol levels. You can conveniently use apps like Calm, Insight Timer, or Headspace or take a meditation course to guide you. Stretching, journaling, or making lists before bed can help you relax and ease your mind at the end of the day, too.



As your hormones change, you can experience a lack of energy and moodiness.


  1. Avoiding alcohol and caffeine can also help with this. They can both trigger irritability. And think about what you can say no to and take off your plate. This will free up mental energy and decrease your stress.



With decreasing estrogen and progesterone comes a rise in cortisol, which can cause weight gain around your midsection that can be pretty difficult to get rid of.


  1. Do cardio. Move your body, but you don’t need to overdo it. Going for a morning walk can help manage weight and regulate your circadian rhythms to help you sleep. The Peloton app has assisted walks, where it plays music and gives you guidance while you’re walking. Or you can listen to a podcast or your favorite playlist.

  2. Do strength training. Skeletal muscles are the largest organ in the body and help to balance blood sugar and burn fat. Do some type of strength or resistance training to manage weight and bone density two to three times a week. Pilates and weight lifting are great—anything that allows you to moderately stress the muscles and create tension.



These can stem from a drop in progesterone, estrogen, and testosterone, as well as an inflamed gut or other gastrointestinal issues.


  1. I’ve found that increasing protein intake, eating cruciferous vegetables, and prioritizing sleep can help. Working with a functional medicine practitioner to evaluate your gut health can be beneficial, too.



Hair thinning can be due to changes in thyroid, low protein intake, decreased testosterone, or a combination of the three.


  1. Get quality nutrition. Eating a diet rich in protein, quality fats, and lots of nutrients can help. Supplements with biotin and vitamins and minerals can be beneficial for hair growth and strengthening. And if you have the bandwidth and desire, you can make your own bone broth.

  2. Wash your hair less frequently. A lot of people overcleanse their hair. I suggest taking a gentle approach by washing your hair less often and using shampoos and conditioners without harsh chemicals or hormone disruptors.


These are my starter HRT tips—for a more in-depth conversation, listen to my conversation with Gwyneth on The goop Podcast.

  1. Prep. Before anyone starts HRT, it’s beneficial to make sure your body is ready. If not, it can make you feel worse. Get your hormones tested prior to HRT so you can determine what’s really going on in your body and whether you’re a good candidate for it. Some women are not ready for HRT until they support their detoxification pathways, and testing will let them know that.

  2. Start early. The optimal time to introduce hormones is during perimenopause—not a year into menopause and certainly not after 5 or 10 years. Work with a functional medicine doctor and a dietitian to get the proper testing and care you need. And monitor your hormones every three to four months. I recommend the DUTCH test, a GI-MAP (Gastointestinal Microbial Assay Plus, and comprehensive blood testing.

  1. Do a DUTCH test. This test uses five urine samples that provide a comprehensive measurement of your hormone levels, including how well you detox your hormones, ratios of estrogen to progesterone (to see if you’re estrogen dominant), cortisol levels, melatonin production, and even B vitamin levels.

  2. Get a GI-MAP. The healthier your gut is going into menopause, the easier your transition into menopause will be. The GI-MAP is a stool test that tells me all about your gut health and helps get to the underlying gut issues that cause bloating, constipation, brain fog, depression, anxiety, and sluggishness. It tells me if you’re reabsorbing estrogen into your gut or excreting estrogen properly and if you have inflammation in the gut, gluten sensitivities, leaky gut, pathogens, or parasites.

  3. Get comprehensive blood tests. I look at your inflammatory markers, insulin, glucose, comprehensive thyroid panel, magnesium, vitamin D, zinc, and more.

Once I have the information from these tests, I usually make health recommendations and connect my clients to a functional medicine doctor who can prescribe and monitor hormones. Most people ask, “Can’t I just go to my general practitioner or my gynecologist for hormones?” You can, but the person you’re trusting with your hormone health needs to be well-versed in hormones.

  1. Take bioidentical hormones. Bioidentical hormones that are the most physiologically compatible with female hormones are the best options. Synthetic estrogen and progesterone don’t have the beneficial effects on the brain that bioidentical forms do. For example, bioidentical progesterone is a precursor to GABA, which is a calming neurotransmitter in the brain that helps you sleep and feel less irritable. Bioidentical estrogen can help eliminate hot flashes and vaginal dryness and can help rebuild collagen in the vaginal walls.

  2. Start with low doses. HRT involves microdoses of hormones—doses that are a fifth of the dosage of a birth control pill. Starting with very low doses of bioidentical oral progesterone, like Prometrium or a troche, to balance higher estrogen levels can be wonderful for taking the edge off your periods and controlling the blood flow. Low doses of topical testosterone can improve libido and muscle mass and increase energy levels.

When you finally enter menopause and you no longer have periods, your hormones are steadier. Mood swings and irritability improve. You’re in a much more stable hormonal place.

After enduring all the symptoms for many years, you can have a party to celebrate—it’s really a time of freedom. You can get rid of all your tampons, menstrual cups, or whatever you use. If you’re comfortable physically, you can have sex whenever you want. You don’t have to worry that you’re going to get your period while you’re traveling, on New Year’s Eve, or on your birthday. You’re no longer concerned about getting pregnant or taking birth control. You can wear white pants whenever you like. And it’s typically a time in a woman’s life when she is the most powerful and confident and knows who she is and what she wants.

It’s worth the journey. Cheers to getting to the other side!

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