Every woman who makes it to middle age eventually experiences menopause. It's the second major hormonal shift in a woman's life after puberty in adolescence, and it marks the end of fertility.

Perimenopause is synonymous with the transition into menopause. It also happens to be the time when many women begin experiencing the negative side effects of this hormonal shift. Finding the right approach to manage your symptoms — whether it's going the conventional medical route, using perimenopause supplements, or some combination — is key to helping you get through this transition, which can last for multiple years.

There are many natural options available for perimenopausal relief, but they aren't all backed by hard science. We're going to go through all of the available options and explain what science supports and where more work needs to be done. From there, you can decide which options you'd like to try, based on what you think could work for you.

Defining Perimenopause

The word perimenopause literally means "around menopause" in Greek, although most people refer to it as the transition into menopause (1). Some women begin experiencing signs of perimenopause as early as their mid-thirties, but many women experience changes in their forties.

During perimenopause, estrogen levels change and become less consistent than they were when you were in your teens and twenties. In other words, your menstrual cycle might become inconsistent. You might also notice other symptoms like vaginal dryness, night sweats, hot flashes (also called hot flushes), mood swings, and sleep disturbances. All of these are symptoms of perimenopause (2).

Technically, once you haven't had your menstrual period for 12 months straight, that's when you've officially moved from perimenopause into menopause. This change might result in some of the symptoms we just listed subsiding, but in some cases, symptoms may persist.

Importantly, the transition into full-blown menopause comes with another set of risks. Menopausal women are at a greater risk of heart disease, weight gain, and osteoporosis. That's because estrogen provides some protective quality against these conditions (2).

The Natural Approach: Diet, Lifestyle, and Perimenopause Supplements

If you're reading this, it's likely you're looking for a natural approach to managing your perimenopausal symptoms. Before diving into the herbal supplements that can help reduce these symptoms, it's worth taking a look at diet and lifestyle.

Not all women experience perimenopausal symptoms in the same way. Only about half of women going through the change experience hot flashes or sleep disturbances, and even fewer experience mood disturbances (about 10-20%) (1).

These numbers don't diminish the fact that many women deal with these symptoms, but they do mean there's a chance that lifestyle choices can help mitigate the symptoms. Here's a look at some of the lifestyle factors that can affect your experience of perimenopause.

Diet

What you eat has a huge impact on how you feel, regardless of your hormonal situation. But with shifting hormonal levels, it's even more important to eat for health.

You've probably noticed that it's a lot harder to lose weight as you get older. That's because estrogen levels decline as you enter perimenopause, which has a negative impact on your metabolism (especially your carbohydrate metabolism) and, potentially, on your cholesterol levels (3). Focusing on fiber-rich foods like vegetables, whole grains, and fruit can go a long way toward keeping your weight on track.

Fruits, Veggies, and Whole Grains

You've likely heard the phrase "eat the rainbow." That's because colorful fruits and vegetables are some of nature's most nutrient-dense foods. The colors represent various nutrients available in each of these foods.

Unfortunately, fruits and veggies are also some of the most underrepresented foods in the Western diet, which is filled with processed carbs and packaged snacks. By filling at least half of your plate with vegetables at every meal, you'll ensure that you're filling up on fiber, vitamins, minerals, and antioxidants (4).

Doing this not only helps your waistline, it could also help with symptoms of menopause. In a study of over 17,000 menopausal women, researchers looked at their overall diets and experience of hot flashes. The women eating more vegetables, fruit, fiber, and soy had fewer hot flashes than the control group by 19% (5).

Vegetables in the brassica family — broccoli, Brussels sprouts, kale, etc. — might be of extra importance, as they may decrease levels of the type of estrogen linked to breast cancer (6).

Whole grains, while controversial in certain dietary circles, like with the paleo and keto crowds, are also important to include in a perimenopausal diet. They've been shown to reduce the risk of heart disease, cancer, and early death (7). They're also rich in B vitamins, which can help stabilize your mood if it's being affected by shifting hormonal levels (8).

Omega-3s

It's possible that eating healthy fats like omega-3 fatty acids may help reduce hot flashes and night sweats. Although scientific results are mixed, some studies do support this claim (9). And since we already know that most Americans are in need of more omega-3s in their diet, it doesn't hurt to give it a try.

Fatty fish like wild salmon, sardines, anchovies, and mackerel are all rich in DHA and EPA, the types of omega-3 fatty acids associated with heart and brain protection. By eating bone-in sardines, you also increase your calcium intake, which helps prevent bone loss. For vegetarian sources of omega-3s, try grinding flax seeds, chia seeds, or hemp seeds into your next smoothie. They're also great for baking (10).

Dairy Products

Dairy products aren't right for everyone, but adding in organic, full-fat dairy can help you get the nutrients you need to promote bone health as your estrogen levels decline.

Milk, yogurt, kefir, and cheese contain minerals that can help keep your bones healthy and strong. These minerals include calcium, phosphorus, potassium, magnesium, vitamin D, and vitamin K (11)(12).

Dairy also contains an amino acid called glycine, which helps promote deeper sleep (13). Women who experience sleep disturbances might benefit from adding some more healthy dairy into their diets.

Lifestyle

The term "healthy lifestyle" is a bit of an umbrella term for the choices you make in your day to day life. It's part of a holistic approach to addressing your changing hormone levels in a way that can help support medical intervention like hormone therapy. When it comes to managing perimenopause symptoms, three lifestyle factors make a big difference: stress management, sleep, and exercise.

Managing Stress

Hormonal changes can do a number on your mental state. Changing hormones, hot flashes, and the realization that your reproductive window is closing can create stress for many women. This added stress compounds the normal stressors of life: your family, job, house, social life, etc.

By finding a solid and consistent coping strategy, you can help yourself ease into this major life change. Practices like yoga and meditation, in addition to talking to a professional or finding a menopausal support group, can help ease your transition and allow you to feel supported along the way.

Sleep

Sleep hygiene is difficult to keep up with these days, as we're constantly staring at our screens late into the night. It's important, though. Keeping consistent sleep and wake times, avoiding bright lights at night (putting screens away and dimming the overhead lights), making your room a "sleep only" room, and establishing a bedtime routine will go a long way toward helping you get a good night's sleep.

About 40% of women in the first stages of menopause report having sleep disturbances, so practicing good sleep hygiene is more important than ever (1). To avoid night sweats, keep the temperature low and try using a fan for continuous airflow.

Exercise

Exercise is important throughout life for a number of reasons. It's especially important for women experiencing perimenopause, menopause, and post-menopause. That's because a drop in estrogen has an effect on metabolism, which could lead to weight gain and cardiovascular risk.

Aside from mitigating health risks, exercising can actually help reduce the occurrence of hot flashes, according to some studies (14)(15). Another reason to start exercising is the positive effects it has on bone density. Both aerobic exercise like jogging and anaerobic exercise like weight-lifting have shown positive impacts on maintaining, and even adding, bone mass (16).

Perimenopause Supplements

There are a number of supplements available for women going through perimenopause or general hormonal shifts. Some of these natural remedies are for balancing hormones in women during their reproductive years and beyond. Some are specifically for dealing with the results of hormonal changes, like hot flashes, anxiety, depression, and trouble sleeping. Some are backed by scientific research, and others are more like home remedies that require more tests.

Grape Seed Extract

Grape seed extract may help with hot flashes, sleep troubles, and depression. In one study, 91 middle-aged women took 200 mg of grapeseed extract for eight weeks and reported improvements in these three areas as compared to the control group (17).

Black Cohosh

Black cohosh may also help in the hot flash and mood department by improving receptivity to serotonin. In a rodent study, those taking black cohosh supplements showed promise in this area, but more work needs to be done to understand the relationship and potential risk factors (18). This supplement may interact with some medicines, so talk to your doctor before starting this one to discuss whether or not it’s right for you.

Ashwagandha

Ashwagandha is an Ayurvedic herb used in traditional Indian medicine for its positive effects on anxiety and depression. Ashwagandha is among the more studied natural remedies for mood disturbances. Multiple controlled studies have shown ashwagandha to be effective for helping reduce symptoms of depression and anxiety in both human and rodent studies (19)(20)(21)(22).

Phytoestrogens

Phytoestrogens like red clover, wild yam, and soy isoflavones may also be effective for improving symptoms of perimenopause, although more work needs to be done in this area. Phytoestrogens do have documented positive effects on cardiovascular health, however, so it might be beneficial to use them regardless of their effects on perimenopausal symptoms (23). If you've had breast cancer or are at a higher than normal risk for it, it's important to consult with your health care professional before taking these supplements or increasing your soy consumption.

Omega–3s

Omega–3s, which we covered in the diet section, are also available in supplemental form. You can supplement with both fish oil and flaxseed oil to add more omega–3 fatty acids into your diet.

Managing Your Perimenopause

Female hormones change over time, starting at puberty, throughout adulthood, and into middle age when you begin perimenopause. By taking good care of yourself throughout your life, and especially during these changes, you can help minimize the unpleasant symptoms of perimenopause and menopause.

There are a lot of options for you if you're trying to manage symptoms with alternative methods or in conjunction with HRT and other conventional medical interventions. By starting with diet and lifestyle changes and then adding in some herbal perimenopause supplements, you might end up with a better outcome.

Always talk to your women's health medical professional before making any drastic changes, and listen to your body as you move through this experience.