Perimenopause: Your Body Is Asking for a Different Kind of Support

Perimenopause can feel confusing.

One month your sleep is fine, the next you’re waking at 3am. Your period changes. You feel more tired, your mood feels different, you notice changes in your body, or suddenly those hot flushes appear.

And often, the first thing women hear is:

“It’s just your hormones.”

But there is so much more to the story.

As a Dietitian and Natural Medicine practitioner, I look at perimenopause from a whole-body perspective. Your hormones are important, but so are your nutrition, digestion, stress, sleep, metabolism, body composition and the individual pattern of symptoms you are experiencing.

Because there is no one-size-fits-all approach to perimenopause.

What about herbal medicine?

Herbal and dietary supplements are very commonly used during perimenopause, but I think it is important to be honest about what the research actually tells us.

Not every herb marketed for menopause has strong evidence behind it.

Some have promising results. Others have inconsistent results. And some simply haven’t been shown to make a meaningful difference.

For example, research on black cohosh suggests that it may help reduce hot flushes for some women, although studies have produced mixed results. There are also safety considerations, including rare reports of liver injury, so it isn’t something I would recommend without considering the individual person.

Genistein, a soy isoflavone, is another interesting example. Some studies suggest that higher doses, particularly above around 30 mg per day, can reduce hot flushes. But this doesn’t mean that every soy food or soy supplement will have the same effect.

The preparation, dose and individual response matter.

There is also emerging research around Chinese herbal medicine and perimenopausal insomnia. A meta-analysis of 20 studies involving around 1,700 women found improvements in sleep quality compared with Western medicine. However, the studies varied in quality and the results cannot simply be applied to every woman.

And then there are supplements that are frequently recommended online but haven’t shown convincing benefits for hot flushes.

Red clover, evening primrose oil, dong quai, ginseng and vitamin E are examples where clinical trials have not demonstrated strong evidence for reducing vasomotor symptoms.

So when someone tells you:

“This herb is amazing for menopause.”

My next question is:

Which herb? What preparation? What dose? For which symptoms? And what does the research actually show?

Your body isn’t the same as everyone else’s

This is probably the most important part.

Two women can both be experiencing perimenopause and have completely different experiences.

One woman may struggle with insomnia and anxiety.

Another may have heavy periods and fatigue.

Another may have hot flushes, digestive problems and changes in body composition.

Another may feel relatively well but notice that her recovery from exercise has changed.

They are all going through perimenopause.

But their bodies aren’t asking for exactly the same thing.

That’s why I don’t believe in simply giving every woman the same “menopause diet” or the same herbal formula.

Food is part of the picture

Nutrition becomes particularly important during this stage of life.

We want to think about maintaining muscle, supporting bone health, cardiovascular health, metabolic health and adequate nutrition — not simply trying to make the number on the scale go down.

Protein, fibre, vegetables, fruit, legumes, whole grains, healthy fats and adequate micronutrients can all play an important role.

Research into Mediterranean-style eating patterns, for example, has shown encouraging effects on several cardiometabolic markers in menopausal women.

But even then, your diet needs to make sense for your body.

Your nutritional needs are influenced by your activity, muscle mass, digestion, energy requirements, lifestyle, symptoms and overall health.

And in an integrative approach, I also consider your individual constitution and body pattern when developing a plan.

Natural doesn’t mean “anything goes”

This is something I feel strongly about.

Herbal medicine is medicine.

Plants contain active compounds and can have real physiological effects.

That means they can also have side effects and interact with medications.

So I don’t believe in randomly taking five different supplements because someone on Instagram said they are “good for hormones.”

The right question is:

What is appropriate for you?

Sometimes the answer may be herbal medicine.

Sometimes it may be nutrition.

Sometimes it may be lifestyle and recovery.

Sometimes you may need medical investigation or conventional treatment.

And sometimes it is a combination of all of these.

Perimenopause is not something you simply have to suffer through

Your body is going through a transition.

That doesn’t mean every symptom needs to be “fixed,” but it does mean we can listen to what those symptoms are telling us.

Instead of asking:

“What supplement should I take for menopause?”

I prefer to ask:

“What is happening in your body, and why?”

From there, we can build a plan around the woman — not around a generic menopause protocol.

Because your body is unique.

And your support should be too.

A note on the evidence

Research into herbal medicine for perimenopause is growing, but the quality of evidence varies considerably between herbs, preparations and doses. Some interventions show promise, while others have little or inconsistent evidence.

Always discuss herbal medicines and supplements with an appropriately qualified practitioner, particularly if you take medication, are undergoing medical treatment or have an existing health condition.

References: The Menopause Society (2023); NICE Menopause Guideline NG23; systematic reviews and meta-analyses examining herbal medicines, phytoestrogens, Chinese herbal medicine and dietary interventions in peri- and postmenopausal women.