Perimenopause vs. Menopause: How to Tell Where You Are and How Functional Medicine Can Help

Authored by Dr. Barrett

Photo by Adam Davis on Unsplash

Hormonal transitions are universal but your experience doesn’t have to feel out of control. Whether you’re noticing subtle cycle shifts or are well past your final period, understanding the nuances of perimenopause and menopause empowers you to take proactive steps.

This guide will walk you through:

• The differences between perimenopause and menopause
• Functional medicine insights for identifying your stage
• Testing considerations to guide treatment
• Effective naturopathic strategies to thrive in both phases

Perimenopause vs. Menopause: What’s Really Happening Biochemically?


Perimenopause is the transitional phase when ovarian hormone production becomes irregular.

• Estrogen fluctuates unpredictably. It may spike high some months and plummet the next, driving symptoms like breast tenderness, heavy periods, and mood swings.
• Progesterone steadily declines. Because ovulation becomes inconsistent, progesterone falls first, creating estrogen dominance—a relative imbalance that explains many symptoms.
• Cortisol often rises. Midlife stress can further deplete progesterone (since pregnenolone is diverted toward cortisol production).

Menopause is confirmed after 12 consecutive months without a period.

• Estrogen falls to a consistently lower baseline.
• Progesterone remains very low.
• FSH and LH rise. This is the brain’s way of signaling the ovaries to produce more hormones, though the response is minimal.
• Metabolism, collagen, and bone density shift.

If you don't have a uterus or don't bleed anymore from other procedures such as an ablation diagnosing menopause becomes a little more difficult. We often rely on levels of FSH and LH in these cases.

Clues You’re in Perimenopause
Functional medicine looks for patterns beyond just cycle timing. You may be in perimenopause if you notice:
Cycle variability:

• Periods coming closer together (21–24 days) or skipping months
• Heavier or lighter bleeding

Estrogen-dominant symptoms:

• Breast tenderness
• Water retention
• Worsening PMS

Progesterone deficiency:

• Anxiety, especially at night
• Insomnia (difficulty staying asleep)
• Mid-cycle spotting

Cortisol dysregulation:

• Fatigue that feels “wired but tired”
• Increased sensitivity to stress

How to Confirm What Stage You’re In

Conventional labs:

• FSH and estradiol—higher FSH with low/variable estradiol suggests menopause
• Progesterone (mid-luteal) to confirm ovulation

Functional testing: these tests won't necessarily confirm the stage but they help us manage the symptoms. 

• DUTCH Hormone Test—measures:
  • Estrogen and progesterone metabolites
  • Cortisol rhythm and total output
  • Androgens (DHEA/testosterone)
  • Melatonin levels
• Comprehensive thyroid panel—thyroid shifts often worsen perimenopausal symptoms
• Blood sugar and insulin markers—metabolism changes can accelerate midlife weight gain

Naturopathic Tips for Perimenopause
Perimenopause management is all about buffering fluctuations.

1. Support Hormone Clearance

• Eat cruciferous vegetables daily (broccoli, cauliflower, Brussels sprouts) to help metabolize estrogen safely through the liver.
• Consider DIM (diindolylmethane) or calcium D-glucarate if labs suggest estrogen dominance.
• Stay hydrated and regular—daily bowel movements help excrete excess hormones.

2. Calm the Nervous System

• Magnesium glycinate (200–400 mg before bed) supports GABA and sleep.
• Adaptogens like ashwagandha, rhodiola, or holy basil can moderate cortisol swings.

3. Support Progesterone Naturally

• Vitamin B6, magnesium and zinc are cofactors in progesterone synthesis.
• Vitex (chaste tree berry) can help regulate luteal phase progesterone in early perimenopause.

4. Move Strategically

• Combine strength training (2–3 times/week) to support bone density with low-impact cardio.
• Gentle yoga or restorative practices help downregulate cortisol.

Naturopathic Tips for Menopause
Once hormones settle to consistently low levels, replacement and protection become priorities.

1. Support Bone and Cardiovascular Health

• Weight-bearing exercise + resistance training
• Adequate vitamin D (target 50–70 ng/mL in the blood) and K2 for bone density
• Omega-3 fats for inflammation and heart health

2. Soothe Vaginal and Skin Changes

• Topical vitamin E suppositories for vaginal dryness
• Collagen peptides to support skin elasticity
• Phytoestrogen-rich foods (flaxseed, fermented soy) can help some women with hot flashes

3. Consider Botanical Hormone Support

• Black cohosh: studied for hot flashes and night sweats
• Red clover: contains isoflavones that mimic weak estrogen activity
• Maca: adaptogenic root shown to improve libido and mood

Important: Always consult with a qualified provider before starting botanical hormone support, especially if you have a history of estrogen-sensitive conditions.

4. Explore Bioidentical Hormone Replacement Therapy (BHRT)
If symptoms are significantly affecting quality of life, BHRT can be a safe, effective option when properly monitored. Note: if you want to start BHRT you must do it within 10 year of starting menopause. So make sure to talk to your prescriber about hormone therapy and if it’s right for you before that window closes.


If you’re ready for a personalized approach to feeling your best in perimenopause and beyond, we’re here to help. From advanced hormone testing to naturopathic therapies and lifestyle guidance, our clinic offers compassionate support every step of the way. Schedule a consultation today and take the next step toward balance and vitality.


Excellent resources to learn more:
​
Next Level: Your Guide to Kicking Ass, Feeling Great, and Crushing Goals Through Menopause and Beyond  by Stacy T. Sims, PhD
Especially great for active people and focuses on nutrition, exercise, and performance during menopause.

The New Menopause by Mary Claire Haver, MD
This book offers a science-backed toolkit for hormonal transitions including diet, lifestyle, emotional health, and self-advocacy strategies to thrive through perimenopause and menopause

The Menopause Brain by Lisa Mosconi, PhD
Written by a neuroscientist, this groundbreaking book explores how estrogen decline affects brain structure, function, and cognition—and explains why menopause can be a “brain renovation project.” It’s full of actionable advice on diet, lifestyle, and HRT.

Hormone Repair Manual by Lara Briden, ND
A naturopathic classic offering clear protocols based on cycle phase, covering thyroid, adrenal, metabolic, and hormone health for women in midlife.


Podcast Episodes to check out:

The Menopause Brain episode on Hello Menopause – Neuroscientist Lisa Mosconi discusses cognitive changes during menopause and brain health strategies
​
Dr. Mary Claire Haver MD on the Huberman Lab podcast

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