By Madeline Sheppard, BHSc (Naturopathy), BPsychSc (Counselling), Living Holistic Health — natural remedies for perimenopause are searched for constantly and sold even more often. This article explains what a naturopath actually does with them, what the evidence supports, and where they sit alongside your GP.
Did you know the word remedy comes from the Latin remederi, to heal again? Not to mask, and not to override. To restore what was already there. I like that, because it is a fair description of how naturopathy approaches the menopause transition.
In recent years there has been growing interest in natural remedies for perimenopause, and a great deal of confident advice with very little behind it. Some approaches have reasonable evidence. Many do not. A naturopath’s job is to tell the difference, and to fit what works into the shape of your own life.
This article sits alongside our perimenopause series. If you want the mechanism behind your symptoms, start with what is actually happening in your forties. Here I want to answer a more practical question: what does working with a naturopath through this transition actually look like?
What Are the Natural Remedies for Perimenopause That Actually Work?
The natural remedies for perimenopause with the best evidence are not products. They are a Mediterranean-style way of eating, cognitive behavioural therapy for insomnia, regular strength and aerobic exercise, a daily stress practice, and attention to gut health. Herbal and nutritional support can help specific symptoms, but it sits last, and it needs a practitioner who knows your history.
Naturally, that order surprises people. It surprised me early in practice too. Yet the trials are clear. According to PubMed, a large Australian cohort found women eating a fruit-rich or Mediterranean-style pattern were about twenty per cent less likely to report hot flushes and night sweats. A randomised trial in perimenopausal women found telephone-delivered CBT-I improved sleep substantially more than menopause education, with gains holding at six months.
By contrast, a systematic review of 62 trials of plant-based therapies in JAMA found modest reductions in hot flushes from phytoestrogens, no significant effect on night sweats, and a high risk of bias in three quarters of the studies. So: real, modest, uncertain. That is the honest summary of the herbal evidence, and it is why herbs come after food, sleep and movement rather than before.
Why “natural” is not the same as “safe”
However, several herbs used in this area interact with medications or are unsuitable in liver disease and hormone-sensitive cancers. Iron taken without testing can accumulate to harmful levels. First, do no harm is the oldest principle in naturopathy, and it applies to a supermarket shelf as much as to a prescription pad.
How Does a Naturopath Assess Perimenopause?
A naturopath assesses perimenopause by listening first: your cycle history, your symptoms and their timing, your sleep, digestion, diet, stress load and family history. We do not diagnose perimenopause and we do not treat it as a medical condition, but we do support you through it. Where something needs ruling out, we refer you through your GP for pathology, then build a plan around what the whole picture shows.
In practice a first appointment with me runs like this. An introduction to how naturopathy works, so you know what to expect. Your current concerns and goals. Your medical history. A dietary and lifestyle breakdown. Then a tailored plan with obligation-free suggestions for herbal or nutritional support alongside dietary and lifestyle changes. Where warranted, a referral through your GP for pathology, or to rule out any red flags.
Notably, that last step matters more in perimenopause than almost anywhere else. Iron deficiency from heavier periods, thyroid change and sleep apnoea all mimic the transition and all need their own investigation. Our perimenopause testing article sets out what to ask your GP for.
What Natural Remedies for Perimenopause Do We Start With?
We start with the fundamentals because they change the terrain everything else happens on: a Mediterranean-style diet with protein at each meal, sleep protected through evidence-based methods, strength training twice a week, a daily practice that switches the stress response off, and a gut that works. Each one has trial evidence in midlife women. Together they make any later support work better.
Food
In short: vegetables, fruit, legumes, wholegrains, nuts, olive oil and fish, with 25 to 30 grams of protein at each meal. Whole soy foods such as tofu, tempeh and edamame if you enjoy them. Less alcohol, because it fragments the second half of the night. Our menopause diet article sets out the plate in full, including what changes for bone and blood sugar.
Sleep
Broken sleep drives fatigue, mood, blood sugar and appetite, so it is usually the first thing we work on. Sleep hygiene alone performs poorly in trials; sleep restriction and CBT-I perform well. Our article on perimenopause fatigue explains the 3am wake and what actually helps it.
Movement
Meanwhile, muscle is lost faster through the transition and fat moves centrally. Resistance training rebuilds the muscle that keeps insulin sensitivity working; aerobic exercise has the strongest evidence for reducing deep abdominal fat. Both, most weeks. Vigorous exercise late in the evening raises core temperature at the wrong end of the day, so timing matters.
Stress and the nervous system
Fluctuating ovarian hormones change how the brain’s stress system is regulated, which is why many women feel more reactive at exactly the point their sleep is worst. Reviews of mind-body therapies in the transition show benefits across sleep, mood and hot flushes together. Meditation, breathwork, a walk without your phone. The form matters less than doing it daily.
Gut health
Finally, a community of gut bacteria, the estrobolome, helps decide how much oestrogen is recycled back into circulation. Fibre from a wide range of plants feeds it. Bloating, reflux and irregular bowels are addressed early rather than left for later, and new persistent bloating always goes to your GP first.
Where Do Herbs and Supplements Fit Among Natural Remedies for Perimenopause?
Herbs and supplements fit last, chosen for a specific symptom, for a defined period, and only after your medications and history have been checked. Some preparations have reasonable trial support for hot flushes; the quality of that evidence varies considerably. Nothing here is a cure, and nothing here replaces menopausal hormone therapy where that is the right choice for you.
When I do suggest herbal or nutritional support, three rules apply. First, it is obligation-free. Second, it is specific to your picture rather than a standard protocol. Third, it is chosen not to interfere with anything your GP has prescribed. In fact, many of the women I see use MHT or other medical treatments, and the plan is built to sit beside them, never instead of them.
What we will not do
We will not sell you a “hormone balancing” bundle. Nor will we suggest stopping or changing a prescribed medication, and we will not run hormone testing that cannot answer the question being asked. Naturopathy is sometimes described as alternative health care; in truth it is one of the oldest and most traditional forms of health care there is, and it works best in partnership with modern medicine rather than in competition with it.
How Long Do Natural Remedies for Perimenopause Take to Work?
Generally, expect weeks for sleep and energy, and months for body composition, cholesterol and blood sugar. The transition itself typically runs four to eight years, and frequent hot flushes lasted a median of more than seven years in the largest study to date. The aim is not to make the transition disappear. It is to change how your body moves through it.
Practically, we review at four to six weeks, adjust what is not working, and keep the plan simple. Previous patients are welcome back regardless of how long it has been between appointments, because a transition this long is not a single fix.
When Should You See Your GP Instead?
See your GP first for very heavy or prolonged bleeding, bleeding between periods or after twelve months without a period, chest pain or palpitations that worry you, severe low mood, or symptoms before the age of 45. These need investigation before anything natural is considered. We work alongside your doctor on the rest, and menopausal hormone therapy is a decision that sits with them.
Getting Started With Natural Remedies for Perimenopause
Practically, if you would like a plan built around your own transition rather than a protocol, you are welcome to get in touch and arrange an obligation-free conversation at our Geelong or Drysdale rooms, or by telehealth.
Frequently Asked Questions
What is the best natural remedy for perimenopause?
There is no single best one. The strongest evidence sits with a Mediterranean-style diet, CBT-I for sleep, regular strength and aerobic exercise, and a daily stress practice. Herbal and nutritional support can help specific symptoms, modestly, and should be chosen with a practitioner who knows your medications.
Can a naturopath help with perimenopause?
A naturopath does not diagnose or treat perimenopause as a medical condition. What we do is work alongside your GP on the factors that shape how it feels: diet, sleep, movement, stress physiology and gut health, with evidence-informed herbal or nutritional support where it is appropriate and safe.
Are natural remedies for perimenopause safe with HRT?
Many are, but not all. Some herbs interact with medications or are unsuitable with a history of hormone-sensitive cancer. Tell your naturopath everything you take, and tell your GP what your naturopath suggests. The plan should be built to sit beside your medical treatment, never instead of it.
Do I need hormone testing before starting natural remedies?
Usually not. Hormone levels fluctuate so much in perimenopause that a single result means little, and guidelines advise against routine testing over 45. Testing for the things that mimic the transition, such as iron studies and thyroid function, is far more useful, and your GP orders those.
How much do natural remedies cost?
The most effective ones are free: what you eat, how you sleep, how you move, and how you switch off. Where herbal or nutritional support is suggested it is obligation-free. For private health consultation claiming, please enquire with your health fund to assess coverage.
References
Studies on natural remedies for perimenopause
The following were retrieved via PubMed.
- Franco OH, Chowdhury R, Troup J, et al. Use of plant-based therapies and menopausal symptoms: a systematic review and meta-analysis. JAMA. 2016;315(23):2554-63. https://doi.org/10.1001/jama.2016.8012
- Taku K, Melby MK, Kronenberg F, Kurzer MS, Messina M. Extracted or synthesized soybean isoflavones reduce menopausal hot flash frequency and severity: systematic review and meta-analysis. Menopause. 2012;19(7):776-90. https://doi.org/10.1097/gme.0b013e3182410159
- Herber-Gast GC, Mishra GD. Fruit, Mediterranean-style, and high-fat and -sugar diets are associated with the risk of night sweats and hot flushes in midlife. Am J Clin Nutr. 2013;97(5):1092-9. https://doi.org/10.3945/ajcn.112.049965
- McCurry SM, Guthrie KA, Morin CM, et al. Telephone-based cognitive behavioral therapy for insomnia in perimenopausal and postmenopausal women with vasomotor symptoms: a MsFLASH randomized clinical trial. JAMA Intern Med. 2016;176(7):913-20. https://doi.org/10.1001/jamainternmed.2016.1795
- Woods NF, Mitchell ES, Schnall JG, et al. Effects of mind-body therapies on symptom clusters during the menopausal transition. Climacteric. 2014;17(1):10-22. https://doi.org/10.3109/13697137.2013.828198
- Ismail I, Keating SE, Baker MK, Johnson NA. A systematic review and meta-analysis of the effect of aerobic vs. resistance exercise training on visceral fat. Obes Rev. 2012;13(1):68-91. https://doi.org/10.1111/j.1467-789X.2011.00931.x
Studies on the transition, testing, gut and body composition
- Santoro N. Perimenopause: From Research to Practice. J Womens Health. 2016;25(4):332-9. https://doi.org/10.1089/jwh.2015.5556
- Avis NE, Crawford SL, Greendale G, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015;175(4):531-9. https://doi.org/10.1001/jamainternmed.2014.8063
- Sarri G, Davies M, Lumsden MA. Diagnosis and management of menopause: summary of NICE guidance. BMJ. 2015;351:h5746. https://doi.org/10.1136/bmj.h5746
- Gordon JL, Girdler SS, Meltzer-Brody SE, et al. Ovarian hormone fluctuation, neurosteroids, and HPA axis dysregulation in perimenopausal depression. Am J Psychiatry. 2015;172(3):227-36. https://doi.org/10.1176/appi.ajp.2014.14070918
- Baker JM, Al-Nakkash L, Herbst-Kralovetz MM. Estrogen-gut microbiome axis: physiological and clinical implications. Maturitas. 2017;103:45-53. https://doi.org/10.1016/j.maturitas.2017.06.025
- Greendale GA, Sternfeld B, Huang M, et al. Changes in body composition and weight during the menopause transition. JCI Insight. 2019;4(5):e124865. https://doi.org/10.1172/jci.insight.124865
This article is general information and not a substitute for individual medical advice. Please speak with your GP before starting, changing or stopping any medication or supplement. For private health consultation claiming, please enquire with your health fund to assess coverage. Nutrition consultations are covered by some private health funds — please check with yours first.
