Is it just me, or did you make it to perimenopause without knowing that was a “thing”? Growing up, I heard about menopause, but just barely. I knew there would be hot flashes and no period. Nothing else. But I had never even heard of perimenopause when I found myself at 46 with mood swings, hot flashes, and some weird periods.

I went to my PCP, using my insurance, and she said “we can put you on birth control, but there isn’t anything else to do.”

Here me now, women: that is utter nonsense.

First of all, the pill has been found to be very dangerous. Please research this on your own. It isn’t my belief. It’s a fact. I had never been on the pill for this reason. Why would I start taking it at 46 years old?

a doctor showing something on a tablet to a woman

Luckily, my Naturopathic doctor was ready for me: she patiently explained what was actually happening in my body. We did tests to get a sense of my hormones and other bodily systems that support hormones (alas, something my PCP didn’t even mention!). Then, we experimented with supplementation to support my body’s natural ability to make estrogen and testosterone and explored the importance of DHEA and progesterone to complement their impact.

I’m not going to lie: it wasn’t a miracle cure. But, I did have more balance and some relief from the symptoms. All without toxic drugs.

When Menopause started four years later, I was prepared.

Perimenopause and menopause aren’t just “hormones going haywire.” They’re a comprehensive neuro–endo–metabolic transition that impacts both your physical AND mental health. From my perspective as a therapist, I have found two broad needs for women during this time: nervous-system balance and practical strategies for preventing and managing the symptoms.

Below is a compact, science-informed menu you can tailor. I’ll weave in insights from Dr. Stacy Sims (exercise physiology), Dr. Lisa Mosconi (women’s brain health), and Dr. Mary Claire Haver (nutrition in midlife). While giving advice about physiological interventions is outside my scope of competence, supporting women psychologically during this time is my passion.

a person pointing to a clipboard as they engage in data tracking

1) Reframe the story—and track the data

Start by naming what’s happening: your body is recalibrating, not failing. Feel your feelings around this time in your life: perhaps grief that your reproductive years are over, anger that you feel so unstable, fear that you don’t know what to do. Acknowledge those feelings and hold the belief that your body is doing it’s natural course of action to transition you to becoming a senior.

You are not done with being a woman. You are transitioning to a new stage. This mindset matters.

Then empower your-Self. Seek medical support: I have the priviledge of being able to pay out of pocket for Naturopathic care. I realize not everyone can do so; but you can advocate for your-Self with your Allopathic (Western Medicine) doctor. Don’t accept just any advice. Bring them the research that you find about options for treatment.

Start tracking sleep, cycles/bleeding changes, hot flashes, mood, nutrition, and exercise in connection with how each leaves you feeling. Meaning, write this down. You may notice, for instance, that you get more fatigues doing cardio now or that your moods are worse late in the day. Patterns tracked/written down beat guesswork or relying on your memory to tell your practitioner what is happening. From there, you can help your clinician tailor options to your actual symptoms.

Another thing to remember: there is no one-size-fits all when it comes to these changes. You are unique, so tracking what is happening for YOU matters. I’m passionate about practicing precision medicine. For myself, and with my clients. Meaning, your unique genetic and epigenetic factors must be considered in any medial setting. For instance, with my genetics there were certain interventions that were off the table. If my doctor had not taken the time to learn about me, she would have offered me things that were contraindicated.

Again: no one-size-fits all.

older woman with boxing gloves on and a focused look on her face

2) Exercise like a midlife athlete (not like your 25-year-old self)

Estrogen’s decline reduces muscle protein synthesis and bone remodeling. The advice women have received for how to exercise has historically been based on male data. But, as Exercise Physiologist Dr. Stacy Sim’s quips, “Women are Not Small Men.”

As women enter into perimenopause they need to adjust their training to fit what is happening in their bodies. Let me share the highlights here, but do dig into Dr. Sim’s research and advice further to learn how to adjust this protocol to match your fitness and health level. This is an overview, not all there is to it:

Strength training: 2–4 days per week of lifting as heavy as possible and involving compound movements for maximum impact (lower-body pushes/pulls, hinge, squat, press)
Sprint training: this is Dr. Sim’s counter to HIIT training. It’s a bit different. She recommends short bursts of maximum output followed by longer periods of recover for four to five rounds up to three days weekly. I’ve had a hip replacement, so running is off the table. To achieve this maximum output required of Sprint training Sim’s has myriad options.

I do squat thrusters, high knees, and even jumping jacks sometimes to get my heart rate to zone 4 or even 5. I get a little assist by doing this in the sauna so the heat stress makes my heart rate go up even more. Start with this video short to get a sense of Sprint training included the length of the intervals here: Sprint interval training for women in their 40’s?! How to do it properly!! #drstacysims
Jump training: the final recommendation for training is Jumping! Work up to three days a week, ten minutes at a time, to help stave off bone loss. Reports show on average women lose 3% or more of their bone density each year of menopause.Read that again! That’s a significant number that points to the risk for osteopenia and osteoporosis in women. Also, as your bones degrade they release stored toxins. This toxic burden causes incredible stress on your body. No one ever spoke to me about bone loss! This was shocking news and especially horrifying to know that with just a minor intervention, jumping, we could prevent this loss? Why didn’t anyone tell me?

My surgeon who performed my hip replacement gave me the green light after 6 months of healing to give it a try. But do check with your doctor. Note, though: many might not have this updated information. You might have to educate them. Don’t be shy: they are only human. They need educating, too. For more guidance on the specifics of jump training, download the free app called Osteo-gains, and listen to Dr. Sims discuss jump training here: Can Jumping Really Reverse Osteopenia? For those of you who have bad knees, don’t exercise, or are concerned, you can start with lighter movements: Dr. Stacy Sims – YouTube and What Are the Benefits of Plyometric Training for Women?

Cardio remains a tool, but swap endless steady state for brisk zone-2 walks on recovery days and brief intervals for potency. She calls things like walking, yoga, and gentle bike riding as exercise for your soul. Do that! But know, that isn’t the type of exercise that is optimal for preventing bone loss, putting muscle on, and managing your hormones. Your joints (and calendar) will thank you. I find this the hardest for my clients. They love walks! Again, keep them, just add in the resistance, sprint training, and jump training.

Beyond fitness suggestions, Dr. Sim’s and others recommends combining your exercise with intentional eating. Most importantly, she points out that women tend to under feed themselves. Or, they feed themselves inappropriately for what their body actually needs. Let me share some highlights from her recommendations:

Protein matters. Distribute high-quality protein evenly through the day; older women often need more per meal than they think. Sims summarizes targets in the range of ~1.4–2.2 g/kg/day for peri/post menopause, spaced every 3–4 hours to support lean mass. And, the timing of protein matters.

You need to have some protein and potentially carbohydrate “onboard” before you train and then for women there is a feeding window after exercise that you need to refuel. It’s hard to do, but I can vouch that it makes a difference. For years I exercised fasted (without eating) and then I would eat maybe an hour or two after exercise. Nope. You might be okay when you are younger, but this is going to be bad for you in the long term when you are in perimenopause or menopause. Check out her suggestions for timing of food relative to training: Dr. Stacy Sims Explains What to Eat Before & After Training: Pre/Post Workout Meals for Women & Men

Dr. Sims talks about the dangers of unskilled eating in terms of “low energy availability.” Think about that: could you use more energy? Yeah, I thought so. Timing of eating matters. Meal Timing for Women: When to Eat Around Workouts for Hormonal Balance & Health | Dr. Stacy Sims

Consider creatine. Creatine monohydrate (3–5 g/day) is well studied, inexpensive, and supports strength, cognition, and mood—benefits especially relevant in midlife; Sims repeatedly highlights it for women. Momentous. She also recommends other supplements. I will let you hear it from her.

graphic of a human brain holding two barbells over head

3) Focus on brain health

Neuroscientist Dr. Lisa Mosconi’s imaging work shows menopause is a brain transition: energy metabolism shifts, and symptoms like brain fog, sleep disruption, and hot flashes have real neural correlates. Supporting brain health—alongside hormones—should be standard, not “alternative.” Shocking Truth: How Menopause Diet Can Save Your Brain! | Dr. Lisa Mosconi

Build a brain-forward plate:

A Mediterranean-leaning pattern rich in fish/omega-3s, extra-virgin olive oil, nuts/seeds, legumes, leafy veg, and deeply colored fruits.
Ample fiber for gut–brain cross-talk and estrogen metabolism.
Stable blood sugar: anchor each meal with protein + plants + fiber+ healthy fat. (Brain fog loves glucose rollercoasters.)
Avoid processed foods and eliminate ultra-processed foods. If you don’t know what that means, google it, and I highly recommend the book Good Energy by Dr. Casey Means that I list on my Resources page.

Sleep is brain medicine: form consistent wake/bed times (sleeping and waking within 15-30 minutes of the day before), get outdoor light within an hour of waking (no sunglasses, but don’t look at sun, for about 15 minutes after waking), cool your bedroom (65-69 degrees), stop screens of all kind 90-minutes before bed, and keep late caffeine/alcohol off the table—both aggravate vasomotor symptoms and sleep fragmentation that worsen cognition. (Mosconi emphasizes that brain fog is usually temporary and improves post-transition.)

chalkboard with word inflammation on it in all caps and a stethoscope

4) Lower inflammation and tune metabolism

OB-GYN Dr. Mary Claire Haver centers an anti-inflammatory, whole-foods approach: plenty of non-starchy vegetables, quality proteins, high-fiber carbs, nuts/seeds, and unsweetened beverages; eliminate ultra-processed foods, added sugars, and eliminate all alcohol. Yes: ALL alcohol. It is not good for you in general and horrible for you specifically during this time. Many women notice calmer symptoms and easier weight stability when they shift this way. The Galveston Diet The ‘Pause Life by Dr. Mary Claire Haver

She also discusses time-restricted eating as one lever among others. If you experiment, keep it gentle (e.g., 12–13 hours overnight), protein-forward, and abort if sleep, mood, or training quality dip; fasting can be more stressful for some women in perimenopause. The ‘Pause Life by Dr. Mary Claire Haver

5) Nervous-system tools you can actually use

Hot flashes, night sweats, and erratic sleep sensitize the stress response. Simple, repeatable inputs help to calm the nervous system down: recommendations from therapist Laura Fish:

Breath with a longer exhale: 4,7,8 breath helps calm your nervous system. Do this five minutes at a time, three times a day. Watch this video to see the practice in action but ignore the suggestions for how often to do it as he has since changed his recommendations: Dr. Weil explains how to do his 4-7-8 breathing technique. Relaxing Breathing Exercise
Vagus Nerve Stimulation: the vagus nerve in a nutshell helps us with balance, calm, and resting. We could all use a bit more of that feeling, right? I know: but you don’t have time! I got you. Here are some simple exercises you can do while you watch TV at night: Relieve Stress By Enhancing Vagal Tone — Laura Fish Therapy
Yoga Nidra: nope, it’s not yoga as you know it! In this practice, also known as Non-Sleep-Deep-Rest, you receive a guided tour of your nervous system that promotes the release of cerebral spinal fluid to detox your brain. I’ve vetted practitioners for you and explain a bit more about this practice here: Non-sleep Deep Rest, Or Yoga Nidra — Laura Fish Therapy

These interventions are free, natural, and don’t require you to drive anywhere! Instead, you have to develop the habit of providing time and space to care for your-Self.

two women of color looking at each other as if they are planning and one woman is writing notes

6) Create your support plan

Movement/nutrition: Use Sims-style programming and protein planning to protect muscle and bone. Dr Stacy Sims
Brain health: Follow Mosconi’s brain-savvy lifestyle pillars to steady cognition and mood. The Menopause Brain
Inflammation/metabolism: Borrow Haver’s anti-inflammatory framework and meal structure. The Galveston Diet
Therapist tools: skillful breathwork, vagus nerve practices, and brain health practices. Engage in boundary-setting, sleep rituals, and values-based action (say “yes” and “no” on purpose) keep your nervous system from doing all the compensating.
And literally, human support. Dr. Vivek Murthy, our surgeon general, championed research that showed that loneliness is as deleterious to our health as smoking: US surgeon general Vivek Murthy: ‘Loneliness is like hunger, a signal we’re lacking something for survival’ | Life and style | The Guardian. Pleaes note: not all socialization is quality. Reassess who you feel rejuvenated being around and who drains you. Say no to social invitations that feel like obligations and yes to those that feed your soul. If not now, when????

human hand writing on chalkboard the words time to start and a picture of a clock

To get you started, try this plan:

3-4 strength sessions (full-body, heavy for you), on average 30-45 minutes per session
2-3 sprint training sessions (short, hard efforts + full recovery), each session averaging about 10 minutes
3 jump training sessions for a total of 10 minutes
Food timing: pay attention to how much protein and carb you have on board depending upon what exercise you are doing that day
Mediterranean-leaning meals with high fiber and omega-3s; avoiding all ultra-processed foods. The ‘Pause Life by Dr. Mary Claire Haver and Good Energy by Dr. Casey Means.
Sleep routine: practice good sleep hygeine + morning outdoor light to balance circadian rhythms.
Socialization: play, laugh, and just “be.” Put the doing on hold.
Track symptoms and adjust—your plan should fit you.

Perimenopause and menopause are not a cliff; they’re a training block for your future self. With athlete-style strength, brain-savvy nutrition, inflammation-lowering meals, and a calmer nervous system, you can feel strong, clear, and engaged on the other side. Even if you have never considered yourself an athlete.

If you find you need mental health support during this transition, I am happy to help. Contact me to set up a session. As with the physical symptoms, you do not have to suffer with mood swings, depression or anxiety.