Beyond Hormones: A Whole-Person Approach to Perimenopause
A woman may arrive in clinic in her forties or early fifties saying that she no longer feels quite like herself.
Perhaps she is sleeping badly. Her concentration has changed. She feels more anxious, less able to tolerate stress, increasingly tired, or frustrated by brain fog. Her cycle may have become unpredictable. Hot flushes, headaches, digestive changes, reduced libido or changes in mood may have appeared at the same time.
It can be tempting to separate each symptom and look for a different solution for each one.
But perimenopause rarely happens in isolation.
It takes place inside a woman's body, her nervous system, her relationships, her work, her responsibilities, her history and the particular circumstances of her life.
That is why my approach to perimenopause begins with a different question:
What does this woman need in order to adapt well?
Perimenopause is hormonal - but it is not only hormonal
The menopausal transition is fundamentally connected with ovarian ageing and changing reproductive hormones. But the ovaries are not changing in isolation.
Research is increasingly showing that menopause is also associated with changes in brain structure, connectivity, energy metabolism and blood flow. Importantly, these changes should not automatically be interpreted as deterioration. Some of the research suggests that the brain is actively adapting to a changing endocrine environment.
This gives us a much more useful way to think about symptoms such as:
brain fog, poor concentration, changes in memory, sleep disturbance, anxiety, changes in mood, hot flushes, reduced stress tolerance, fatigue, migraine.
Rather than asking only, "Which hormone is low?", we can also ask:
What is making adaptation more difficult for this woman?
The same symptom can have several contributors
Take brain fog.
For one woman, poor sleep may be the most important factor.
For another, chronic stress and an overloaded nervous system may be contributing.
Another woman may be eating irregularly, struggling with blood-glucose regulation or not getting enough protein and key nutrients.
Someone else may be experiencing migraine, significant vasomotor symptoms, thyroid dysfunction, anaemia, medication effects or another medical issue that needs investigation.
And sometimes several of these are happening at once.
This is one reason I do not like reducing women's health to a list of symptoms followed by a list of supplements.
The symptom matters, but so does the context in which the symptom is occurring.
Supporting the terrain in which adaptation takes place
My naturopathic work therefore looks at the wider biological terrain.
Depending on the woman, this may include:
sleep and circadian rhythm
nutrition and blood-glucose stability
digestive function
movement and strength
cardiovascular and metabolic health
stress physiology and nervous-system regulation
hormonal and thyroid factors
nutrient status
migraine and pain patterns
workload, relationships and recovery
appropriate medical investigation where indicated
From there, nutritional supplements or herbal medicine can be selected much more intelligently.
For example, research relevant to midlife and cognitive health has investigated nutrients and botanicals such as resveratrol, Bacopa monnieri, Ginkgo biloba and Hericium erinaceus (lion's mane). Other interventions may be more appropriate when stress, anxiety, sleep disturbance or migraine are the dominant presentation.
The important point is that there is no universal "menopause protocol".
The right intervention depends on the woman sitting in front of me.
The nervous system matters too
Perimenopause can coincide with a stage of life that is already demanding.
Women may be raising children or teenagers, caring for ageing parents, managing relationships, working, carrying financial responsibilities, navigating changes in identity and confronting their own ageing - often while their sleep and physiology are changing at the same time.
This does not mean that menopause symptoms are "psychological".
It means that biology and life experience do not occur separately.
A woman who is sleeping five hours a night, caring for a parent, working full-time and feeling unable to stop cannot be treated as though her hormonal system exists outside that reality.
Sometimes supporting health therefore also means helping the nervous system move out of constant activation.
This is where my background in yoga therapy, breathwork and psychology-informed coaching can sit alongside naturopathic medicine.
Slow breathing, appropriate movement, restorative practices and yoga therapy may help create periods of physiological down-regulation and give the body more opportunity to recover.
Menopause can also be a life transition
There is another aspect of this stage that deserves attention. Many women reach perimenopause and begin questioning areas of life they may have tolerated for years, including work, relationships, boundaries, caregiving, identity, how much they give to others, and what they want the next stage of their life to look like.
This does not mean that every woman needs to reinvent herself during menopause, but sometimes the symptoms create an opportunity to stop, reflect and listen more closely.
My work is therefore not simply about helping a woman return to exactly who she was before perimenopause. Sometimes the more useful question is:
What does she need to become healthier, more resilient and more able to participate in the life that comes next?
How I support women through perimenopause
At Vita Shakti, I bring together naturopathy, herbal medicine, nutrition, yoga therapy, breathwork and psychology-informed approaches.
The aim is not to apply every therapy to every woman.
It is to understand the individual picture first and then decide what support is most appropriate.
That may involve nutritional and herbal support.
It may involve working with sleep and nervous-system regulation.
It may involve yoga therapy and breathing.
It may involve looking more closely at stress, boundaries, workload or patterns that are making recovery difficult.
And where symptoms require further medical assessment, appropriate investigation or referral remains an important part of good care.
Perimenopause is not simply a collection of symptoms to suppress. It is a biological transition occurring within a whole human life.
When we understand more of that whole picture, we can make better decisions about what to support, what to investigate and what may need to change.
If you are experiencing perimenopausal symptoms and would like individualised support
I offer naturopathic consultations for women navigating perimenopause and menopause, integrating nutritional and herbal medicine, lifestyle support, yoga therapy and psychology-informed approaches according to individual need.
You can also work with me through my yoga classes and therapeutic programmes, where we explore practices for nervous-system regulation, resilience, sleep, energy and greater self-awareness.
Vita Shakti - Ignite Your Inner Vitality
References
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Mosconi L, Berti V, Dyke J, et al. Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition. Sci Rep. 2021;11:10867. doi:10.1038/s41598-021-90084-y.
Jett S, Dyke JP, Andy C, et al. Sex and menopause impact brain mitochondrial function in association with amyloid-beta load. Sci Rep. 2022;12:22087. doi:10.1038/s41598-022-26573-5.
Evans HM, Howe PRC, Wong RHX. Effects of resveratrol on cognitive performance, mood and cerebrovascular function in post-menopausal women: a 14-week randomised placebo-controlled intervention trial. Nutrients.2017;9(1):27. doi:10.3390/nu9010027.
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Hartley DE, Heinze L, Elsabagh S, File SE. Effects on cognition and mood in postmenopausal women of one-week treatment with Ginkgo biloba. Pharmacol Biochem Behav. 2003;75(3):711-720.
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Kasper S, Gastpar M, Müller WE, et al. Lavender oil preparation Silexan is effective in generalised anxiety disorder: a randomised, double-blind comparison to placebo and paroxetine. Int J Neuropsychopharmacol.2014;17(6):859-869.
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