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Natural Approaches to Perimenopause

By Marci Scott, ND.

More than 40 million women are postmenopausal, with millions more approaching the end of their menstruating years. Many women are looking to other means besides hormone replacement therapy to help ease their transition during this time.

Perimenopause refers to the transitional period leading up to the end of a woman’s menstrual cycles. It generally encompasses the period two to eight years before menses stop, and one year after the last menstrual period (menopause). This transition is a normal, natural aspect of aging that signals the end of the reproductive years in women. Perimenopausal changes generally begin to occur on average around 47 years of age with menopause occurring around age 51 or 52, but these ages can vary greatly among women.

A decline in ovarian function is ultimately responsible for the onset of menopause. During this time, hormone levels will fluctuate with an eventual overall decrease in estrogen, progesterone, and testosterone. These fluctuations can contribute to a wide range of different physical and emotional experiences among women. Typical signs and symptoms include irregular menses, hot flashes, mood changes, vaginal dryness or urinary dysfunction, changes in reproductive function, and bone loss.

Traditional approaches to perimenopausal and menopausal symptoms include oral birth control pills, hormone replacement therapy (HRT) and antidepressants. There continues to be a very controversial debate about the risks and benefits of HRT. In 2002, the National Heart, Lung, and Blood Institute (NHLBI) halted a major clinical trial of the benefits and risks of combined estrogen and progestin in healthy menopausal women due to findings of an increased risk of breast cancer, coronary heart disease, stroke, and pulmonary embolism. Bioidentical hormones offer women another source for supplemental hormones. Manufacturers claim that these hormones are safer as they are chemically identical to the hormones made in the body. However, they still involve adding hormones beyond what the body produces.

More and more women are turning to other approaches to ease their transition through menopause. The goals of more natural therapies are to provide relief of symptoms while reducing the risk of osteoporosis, cardiovascular disease, and promoting overall health. These options do not increase the risk of other health issues or promote additional side effects.

These methods tend to be very individualized as each woman’s experience and risk factors may be quite different. Dietary changes, nutritional supplements, botanical therapies, and homeopathy can be effective for the management of menopausal symptoms in most women. When these are not adequate, then hormones may be appropriate.

Proper nutrition is vital to maintaining and promoting health. A diet based in whole foods such as vegetables, smaller amounts of fruit, lean protein and cold-water fish, beans, whole grains, nuts and seeds, and healthy fats such as olive oil are recommended. Good water intake and a diet low in sugar, hydrogenated fats, and caffeine is also beneficial. Beans and soy are good sources of phytoestrogens, which weakly bind to estrogen receptors in the body and can have effects on hot flashes, vaginal dryness, bone and cardiovascular health. But soy may not be the wonder food that it was once touted to be. Soy contains compounds such as phytic acid and goitrogens which can lead to mineral deficiencies and interfere with thyroid function. In addition, soy can have elvated amounts of pesticides and other chemical contaminants. If you plan to consume soy, fermented sources such as tempeh, miso, and natto are better choices as the beneficial isoflavones are more available to the body in this form and phytic acid levels are lower.

Nutritional supplements also very effective during this transitional time. A B-complex, particularly vitamin B6, is important for adrenal health and may help alleviate emotional symptoms such as depression and irritability. Antioxidants including vitamin E and C have been shown in studies to help control hot flashes. Calcium, magnesium, vitamin D, and trace minerals are important for maintaining bone health. Fish oil, a great source of omega-3 essential fatty acids, is beneficial for cardiovascular, neurological, and immune health as well as potentially reducing hot flashes.

Botanicals can also play a significant role in managing perimenopausal symptoms. Black cohosh is an herb that has been the subject of numerous studies indicating benefits in vaginal health, mood symptoms, and hot flashes. Vitex has a wonderful affinity for regulating the menstrual cycle. Dong quai, ginseng, trifolium, licorice, and ginkgo have also been traditionally used to support women’s health. It is important to seek professional advice in what herb(s) may be most beneficial to you and reliable sources as there can be much variation in action and quality.

There are many natural therapies with supporting clinical studies demonstrating benefits in addressing perimenopausal symptoms. So if women are feeling good physically and emotionally, this can be a wonderful time of life. It is important for women to realize that this transition does not represent the end of their youth, but to embrace this phase of life with learned wisdom, fewer family obligations, and new opportunities.

Marci Scott

Author Marci Scott is a licensed naturopath physician in North Carolina.


Life-stages, perimenopause, treatment safety, bio-identical hormones, progesterone cream, and estriol lotion.

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Updated: Dec 21 2013