If you’re on social media, you’ve probably come across wellness influencers giving you tips about how to balance your hormones in perimenopause. But perimenopause is categorized by wild hormone fluctuations, so the notion of trying to achieve balance in this phase is a bit like trying to fit a square peg in a round hole. Our goal is to not to balance hormones so much as to reduce the vast hormonal fluctuations to minimize symptoms.

Perimenopause, the years leading up to menopause, means your main sex hormones, estrogen and progesterone, are  fluctuating outside of their normal rhythm. They may surge and wane, and that’s what causes the unpleasant symptoms: hot flashes, night sweats, weight gain, erratic cycles, mood changes.

This is a completely natural and normal phase of a woman’s life. However, perimenopause brings with it a laundry list of symptoms that may not seem like they’re related to hormones (frozen shoulder?), so this transition can be confusing and make you feel like you’re going crazy.

Perimenopause is so deeply misunderstood—by women, doctors, everyone—that many of us have no idea we’re even in it when it happens. I want to change that. Women deserve to understand all phases of their pre and post reproductive years.

So let’s discuss hormone balance in perimenopause.

A Quick Lesson About Cycling Hormones

Please read this. You need to understand how hormones ebb and flow in your body month to month.

The first half of your cycle is the follicular phase where estrogen gradually rises, triggering ovulation, your fertile period. Once ovulation occurs, you enter the luteal phase where progesterone rises. If you do not become pregnant, progesterone dips and your period starts, and the whole shebang repeats itself. While we talk about hormone balance during the reproductive years, it’s more a dance between hormones, and this should be a regular ebb and flow month to month. While there is a balance of sorts between estrogen and progesterone, your hormones are designed to fluctuate in a rhythm.

But during perimenopause, all bets are off. Some months may be totally normal; other months may see wild fluctuations that trigger erratic cycles as well as physical and emotional symptoms.

the hormonal dance of pre, peri, and post menopause

Read more about the phases of the menstrual cycle in this post.

Estrogen generally trends downward, but fluctuates dramatically along the way, rising and falling unevenly, sometimes dropping very low, other times spiking higher than normal. Eventually, in the later stages of perimenopause, estrogen production sinks so low that your ovaries no longer release eggs. At this point, your monthly periods wrap up, and your ovaries are officially in retirement.

You may feel taken by surprise when you hit the perimenopause roller coaster. Menstrual cycles become unpredictable, and you may experience physical and emotional symptoms. Systems that relied on estrogen may struggle to adjust: For example, research shows that estrogen plays a crucial role in preserving your bone strength and density, so its decrease may lead to bone loss and eventually, osteoporosis.

You can think of perimenopause as your body going through estrogen withdrawal.

While the term “balance” might imply a steady state of hormones, what actually happens in perimenopause is that the body is transitioning through a time of imbalance as it adjusts to lower and fluctuating hormone levels. So, it’s not that hormone balance is a myth—it’s more that achieving the same kind of steady balance that was present in a woman’s reproductive years is not likely during this phase.

For some, the experience may feel like a walk in the park, but for others, it’s intense, both physically and emotionally.‍

Am I in Perimenopause?

If you landed here because you are a woman in your 40s or even late 30s or early 50s, and you’re experiencing unexpected and even disruptive symptoms, you are likely in perimenopause. Nearly half of all women have no idea this is a thing, and I want to reassure you that your symptoms are not all in your head.

Perimenopause typically begins around age 47 and can last for several years.

Here are some common perimenopause symptoms/signs of fluctuating hormones:

Supporting Hormones in Perimenopause

Our goal is to minimize the symptoms caused by the huge hormonal shifts that are a natural part of perimenopause. And we can do that with diet, lifestyle, and supplements to ease the fluctuations.

Diet

Your food choices can influence your hormonal health. My main recommendations for this phase and for hormone support are the following:

• PROTEIN: so important during perimenopause. Muscle mass begins to decline pretty rapidly as we reach middle age, and muscle is linked to longevity. Protein breaks down into the amino acids that build muscle. Aim for 30 grams per meal. Beef up especially on your anti-inflammatory omega 3 proteins like wild salmon, sardines, tuna.
• Eat low glycemic to maintain stable blood sugar balance. Too much sugar or refined carbs (think white flour, bread, pasta, sweets) can increase insulin and cortisol leading to weight gain and energy fluctuations.
• Include phytoestrogenic foods like soy (tofu, edamame, tempeh), flaxseed, legumes. These help support dropping estrogen levels and may reduce hot flashes.
• Get at least 30 grams of fiber daily. This supports weight and gut health. May also support cholesterol that tends to rise during perimenopause. Best sources are legumes, fruit (especially raspberries & avocado), and veggies like cruciferous (especially broccoli), leafy greens, artichoke. I use this fiber supplement in my smoothie which boosts its fiber content to over 10 grams.

Lifestyle

• Sleep is a biggie. Sleep quality can decline in perimenopause due to dropping hormones. Fluctuating hormone levels can also bring hot flashes and night sweats, or you might just notice more trouble falling or staying asleep. This is a time to pay extra mind to your sleep hygiene (← click here for my tips). Exercise helps, so engage in regular activity (but not close to bedtime). Declining progesterone can cause fussy sleep in the second half of your cycle, so bio-identical progesterone can help. Please consult with a professional before delving into hormone therapy. And finally, avoid caffeine after 12pm, and avoid alcohol which wrecks your sleep and adds to the waking up at 3am with intrusive thoughts/racing mind issue. For extra support, I have these sleep lozenges on hand for extra support as needed.
• Lift heavy things! During perimenopause, incorporating strength training or weightlifting can help offset muscle loss, improve bone density, and boost overall health, especially as estrogen levels decline. Lifting weights can improve body composition, blood sugar, metabolism, and reduce disease risk. Muscle mass improves longevity! I lift as heavy as I can (10-15lbs currently). I do 3 reps of shoulder presses, squats, flys, triceps, rows. There are tons      of free online workouts you can follow along with. Aim for 2-3 days/week. I mix it up with cardio and yoga.
• Stress management probably seems like a big duh but helps buffer you against the problems that come with chronic stress. Even 5 minutes of meditation or deep breathing before you start your day can help. Create a morning routine which helps to alleviate stress. Read how here.

Supplements

There are a few supplements I recommend to every woman in perimenopause, But one-size-fits-all hormone-balancing protocols will not work because everyone’s needs are different.

The first is this type of maca that supports hormone production. In clinical trials, over 82% of women experienced relief in menopause symptoms such as hot flashes, night sweats, mood swings, stress, low energy and sleep. I have taken this for years, and it is a game changer.

Secondly, almost any woman in her late 40s (and many even earlier) can benefit from progesterone, especially if your cycles are getting closer together. Again, you should consult with a professional on this, as tinkering with hormones if you’re not certain you need them can bring worse symptoms. I use this one.

Thirdly, creatine can support muscle and brain health. Creatine is a molecule that’s naturally found in muscle cells and helps the body produce energy during exercise. It’s common among the gym bro crowd for this purpose. It may be especially important during menopause because of hormone-related changes. Research finds that creatine supplementation can help counteract the menopause-related decline in muscle, bone, and strength by reducing inflammation, oxidative stress, and serum markers of bone resorption. May also support memory and cognition.

Combine creatine with strength training for max results. Aim to get 5g per day! I use this one.

I also often recommend sleep support, omega 3s, magnesium, B vitamins, vitamin D. It depends on each individual’s needs.

Conclusion

Certain life stages, notably puberty, pregnancy, perimenopause and menopause come with huge hormonal changes. Women are taught about puberty and pregnancy but little if anything about what to expect during perimenopause.

Hormonal shifts during this phase can bring all sorts of sudden and unexpected symptoms. Our goal is to support fluctuating hormone levels rather than strive for “balance.” What you may think of as imbalances are actually normal and expected for perimenopause.

Diet, lifestyle, and supplements can ease this phase and prevent or minimize unpleasant symptoms.