Navigating Your Journey with Natural Solutions

We know this time of change can feel confusing - and sometimes a little overwhelming. So, we spoke with Melissa Hohaia, a leading naturopath, to help make sense of what’s really happening during perimenopause, and how to navigate it with natural, evidence-based support.

If you are reading this, it is because you feel like something is changing. 

You are not imagining things. By your late 30s or early 40s something IS changing. It is not a single event, but a process that can last 8-12 years. Think of it like a ‘reverse puberty’ - a time of recalibration that requires a subtle (yet powerful) shift in how you support your health. 

We are having so many more conversations about perimenopause and menopause than we ever have before. It is wonderful that women are feeling validated in their experience, not suffering in silence and being able to seek support more openly. But what I am seeing, is more confusion and overwhelm around this time of change, and often a fear around what is to come. There is an unspoken expectation that it will be a time of suffering and often I see women just blindly accepting feeling terrible just because they are ‘perimenopausal’. I don’t want you to give up hope. I want you to continue to thrive in this powerfully liberating phase of your life. 

The first thing I want you to understand is that perimenopause is not a time of chaotic hormonal fluctuations. It is an intricately orchestrated sequence of events – starting with low progesterone and temporarily high estrogen, and then concluding with low estrogen and significant changes to your metabolism (including reduced insulin sensitivity). Understanding the sequence of events can help you discover the right intervention and treatment approach for where you are at. 

It is also worth noting that perimenopause and early menopause are often a time where  unaddressed smaller health issues can be brought to the surface and evolve into more impactful permanent health problems if not addressed. This is why it is so important to use this time as an opportunity to tune in to your body and not ignore what your body is asking you to pay attention to. If you have been ignoring or abusing your health in your 20s and 30s then perimenopause may potentially be a bumpier ride for you – think of it like a wake-up call where you get the chance to look after your health before something more serious develops. It is never too late to start. 

Before we get into your symptoms and ways you can treat them - let’s take a moment to get clear on the difference between perimenopause and menopause: 

Perimenopause is the 2-12 years leading up to menopause (generally starts late 30s to early 40s). It is worth noting that there is no specific test that confirms you are in perimenopause. Menopause starts when your period has been MIA for more than 12 months – on that anniversary you become menopausal. 

NOTE: There are also times when a women will be prematurely placed into menopause after medical or surgical  treatments – such as chemotherapy, radiation, or hysterectomy (that involved ovary removal). In these situations, they are thrust straight into menopause with no chance for the body to transition normally through all the stages of peri-menopause.

Making Sense of Your Symptoms…The Three Stages  

Perimenopause does not generally start with the typical hot flushes and night sweats that you might remember your mum complaining about - these come in later once estrogen really starts to drop off. It actually starts with a drop in your progesterone levels and a relative increase in your estrogen levels. This drop in progesterone happens as your ovaries stop ovulating as predictably and effectively each month. Progesterone is the calming, grounding, and soothing hormone for your nervous system. It is stress buffering, detoxification supporting, and metabolism boosting – so losing  it can result in symptoms like: 

• Mood changes – irritability, anxiety, depression, and rage being the most common
• Sleep disruption – random 3am wake-ups or issues falling asleep 
• Loss of confidence
• Unexplained weight gain – like when you feel like you are not doing anything different but the weight just keeps on stacking on.
• Worsening allergy symptoms and wine intolerance – as a result of more histamine being released due to higher estrogen levels. 
• Hair loss
• General feeling of ‘flatness’ and social withdrawal
• Headaches and migraines – due to the high and fluctuating levels of estrogen and histamine. 
• Breast pain – classic symptom of high estrogen and loss of progesterone. 
• Period changes – can become heavier, longer, and more painful 

As you move into the later stages of perimenopause, estrogen starts to fluctuate and become more unpredictable. This then results in symptoms like: 

• Hot flushes
• Night sweats
• Brain fog
• Body aches, joint pain and inflammation – random frozen shoulders hit you out of the blue 
• Heart palpitations
• Increase in ADHD symptoms – possibly due to fluctuations in estrogen and their influence on neurotransmitters.
• Changes to your menstrual cycle – becoming more irregular and less predictable, lightening of blood flow. 

Then lastly, estrogen levels drop right off and the symptoms you might experience are: 

• Vaginal dryness and atrophy
• Memory loss
• Further weight gain – especially an increase in abdominal fat
• Cardiovascular complications – heart palpitations
• Bone loss
• Reoccurring urinary tract infections

Natural Remedies to Consider  

Before you read through the following list of natural remedies and decide to try them all, please understand that there is no ideal one-size-fits-all support for perimenopause and menopause. Every woman will have a different response to interventions and various combinations will work better for some people (depending on their specific health situation and genetic factors). You also may find that what works one year may not continue to work – as your hormonal landscape changes. This is why, getting personalised advice from a health professional trained in menopause is highly recommended – you will get better outcomes without any negative side effects. 

Natural remedies 

Adrenal and Nervine tonics – herbs like withania, rehmannia, rhodiola, ziziphus can all help to soothe your nervous system and calm your stress response (super helpful in the absence of progesterone) – helping with energy, mood, sleep, and night sweats/hot flushes. NOTE: that the quality of the herbal formulation you use will correlate to the benefit you experience – I only ever use therapeutic formulas with high-quality formulations.

Important nutrients to explore

Magnesium (chelate or glycinate form) – soothes your nervous system, supports thyroid function, promotes deep sleep, encourages healthy estrogen metabolism,  lowers inflammation, helps stabilise blood sugar levels, prevents cardiovascular disease = 300-400mg daily. 

NOTE: Magnesium and taurine are an effective combination to reduce hot flushes and improve mood.

B vitamins – Specifically… 

B12 (for mood and liver/detoxification support = 1000mcg daily)
B6 (for irritability, rage, and insomnia – 20-100mg daily)
B2 (for migraine sufferers = 200mg 2x daily) 

Zinc (citrate or picolinate form) – Reduces cortisol, improves mood, reduces inflammation, supports skin, hair, and vaginal tissue health = 15-30g daily. 

Vitamin D – needed for bone and heart health, plus it reduces uterine fibroid growth  – 1000-3000IU daily (depending on your existing blood levels). 

Omega 3 (fish oils) – reduces inflammation, supports cardiovascular health, and  improves mood = 2000-5000mg daily (>700mg EPA) 

Estrogen detoxification support and liver love – St Mary’s Thistle, Rosemary, Indole-3- Carbinol, Calcium D Glucarate, Turmeric, Choline + B12 

Progesterone boosting (most effective in early perimenopause) – Chaste Tree (also known as  Vitex) 

Phytoestrogens to buffer declining estrogen (in later stages of perimenopause) – like Black Cohosh, Macca, and Soy (soy isoflavone) 

Blood sugar support – berberine containing herbs and Inositol (2-6g daily)

Vaginal tissue and skin health – sea buckthorn oil (3g daily) + zinc

Lifestyle adjustments that have a big impact  

Often making some consistent shifts in the lifestyle choices you make can have a big impact on how you navigate perimenopause and menopause. I recommend putting your energy towards the  following areas: 

Stress reduction and nervous system regulation.  

Perimenopause often coincides with a stressful time in a woman’s life – kids growing up,  marriage issues, parents aging, career demands, financial pressures, the list goes on. You may feel like you are going through a time in your life where you have been sacrificing your own needs for those around you. You are reassessing where you put what little energy you have. 

The more your body can feel safe and free of life-threatening situations, the better. Helpful approaches can include – time in nature, meditation, deep breathing, hobbies, doing things that bring you joy, connection with loved ones, somatic exercises, meditation, yoga etc. 

Other health stresses like unresolved infections, poor sleep, nutritional deficiencies, poorly  controlled blood sugar levels, elevated toxicity all have a negative impact on your stress levels too. So often the bigger picture needs to be considered and explored if you are experiencing a collection of perimenopausal symptoms. 

Earlier bedtime.  

You might be coming out of raising younger kids, juggling career demands, or delaying your bedtime in the hopes of holding onto every minute you get to yourself free of demands. But staying up late is working against you. You should be aiming to be asleep by 10pm every night – no excuses. 

Alcohol avoidance

Your tolerance for alcohol is reduced in perimenopause and if you choose to drink regularly it will have a big impact on your hormones and how you cope with the changes of perimenopause. 

Blood sugar balancing food choices

As you travel through perimenopause to menopause, and your estrogen levels reduce you will not be as efficient at using glucose for energy. Adjusting your diet to include more protein, fibre and healthy fats will pay off big time. Your sugar and carbohydrate intake needs to be dialled back to keep your waistline lean and prevent insulin resistance and diabetes. 

Connect with regular movement.  

One of the biggest shifts you can make is engaging in regular strength training. Now is the time to pull away from gruelling cardio workouts and prioritise lifting heavy things to maintain your muscle mass. 

Also, walking is a very underrated form of movement for women as they age – getting more steps in over your day (especially right after your meals) is an easy and effective strategy.

A Note on HRT (or MRT – Menopause Replacement Therapy)  

Your decision to use hormone therapy or not will depend on many factors. 

It is worth noting that modern HRT has come a long way and is much safe than HRT from the 90s. There are not the same concerns as there once were and there are some very effective HRT protocols that provide many women relief. Seeking advice from a doctor who specialises in HRT prescription is highly recommended. I would always be suggesting thorough hormone testing (ideally with a DUTCH test) before commencing any HRT protocol. 

If you do decide to explore HRT, then please understand that your other underlying health issues will still be there (such as insulin resistance, sluggish estrogen detoxification, inflammation, autoimmune disease, adrenal dysfunction, nutritional deficiencies), and it will be imperative that you still support these areas of your health if you want to feel good into your 50s and beyond. 

Remember that perimenopause is a transition state and the goal posts will continually shift – what works one year may not work the next – be prepared to adjust your approach. Tap into your body, learn to listen to the cues. 

If you are interested in learning more about how to support your body during your perimenopausal journey (and tame your symptoms), then Melissa has a 4-week online program called The SHIFT that guides you through exactly what you need to put your energy towards. Head to her webpage to learn more or email Melissa directly at hello@melissahohaia.com 

Learn more about her work through her Instagram here.