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Managing Hormonal Changes in Women: A Holistic Approach through Perimenopause and Menopause

How an integrative medicine doctor could help for women's health

The journey through perimenopause to menopause is a pivotal stage that deserves comprehensive and empathetic attention. This is a transformative period marked by significant hormonal changes, and it impacts nearly every aspect of a woman's health.

To address these challenges effectively, a holistic approach is required. An integrative medicine approach, coupled with the guidance from the North American Menopause Society (NAMS) regarding hormone replacement therapy (HRT), can pave the way for a balanced transition.

For many women, the hormonal shifts of perimenopause and menopause can feel like a sudden storm rolling in, disrupting their well-being. Hot flashes, sleep disturbances, and mood swings can leave you feeling out of control and disconnected. 

An integrative medicine doctor can help address the physical, emotional, spiritual, and environmental aspects of your being—and with those pillars, we can create a holistic foundation that can help women navigate this transition with grace and emerge stronger on the other side.

Understanding the hormonal shift

If our bodies are intricate orchestras, than hormones are like the conductors.

During a woman's fertile years, estrogen and progesterone play a lead role, regulating menstrual cycles and nurturing your body for potential pregnancy. As women enter perimenopause, typically in their 40s, these hormonal levels begin their descent.

As women age, the ovaries gradually produce less estrogen and progesterone, the hormones responsible for regulating menstruation and ovulation. This decline leads to perimenopause followed by menopause, officially diagnosed when a woman has gone without menstruating for 12 consecutive months. This can be a gradual process, lasting for several years, or it can happen more swiftly. The result? A disruption in the hormonal symphony, leading to the familiar symptoms of perimenopause and menopause. 

Menopause and perimenopause are characterized by a variety of symptoms that can vary widely in frequency and intensity among women. Here are some of the most common symptoms along with insights into their prevalence:

Hot Flashes: Nearly 75% of women experience hot flashes during menopause. These are sudden feelings of warmth, which are usually most intense over the face, neck, and chest. They can also cause sweating and discomfort.

Night Sweats: Often a nighttime counterpart to hot flashes, night sweats can disrupt sleep. They affect approximately 75% of menopausal women.

Irregular Periods: This is one of the first signs of perimenopause. As ovulation becomes more unpredictable, the length of the menstrual cycle may either shorten or lengthen. Most women experience some degree of menstrual irregularity during this transition.

Mood Swings and Irritability: Fluctuating hormone levels can cause emotional disturbances, affecting about 70% of women. Symptoms can include sudden tears, irritability, and mood swings.

Vaginal Dryness: Around 20-30% of women during perimenopause and up to 50% of women in post-menopause experience vaginal dryness, discomfort during intercourse, and other urogenital symptoms.

Sleep Problems: Difficulty sleeping is reported by many menopausal women, with up to 50% experiencing insomnia symptoms such as difficulty falling asleep or staying asleep.

Decreased Libido: A reduction in sexual desire is common, affecting about 20-40% of women as they transition through menopause.

Cognitive Changes: Some women report problems with concentration and memory during menopause, which may affect about 40% of women.

Weight Gain: Many women experience weight gain due to a combination of hormonal changes, aging, lifestyle, and genetic factors. It's quite common in the menopausal transition.

Joint Pain: An increase in musculoskeletal pains, including joint stiffness and swelling, affects approximately 40-50% of women.

These symptoms are influenced by various factors, including age, lifestyle, and overall health. Managing these symptoms often requires a multifaceted approach, addressing both medical and lifestyle factors.

The four pillars: a holistic, integrative medicine approach 

We at Dignity Integrative have built our approach to integrative and functional medicine around four pillars: nutrition, sleep, movement, and mental resiliency.

Each of these has a role to play.

Nourishing the Physical Body

Diet: As always, embrace a nutrient-rich diet that fuels your body effectively. Think colorful fruits and vegetables, whole grains, lean protein sources, and healthy fats like those found in avocados and nuts. Consider the Mediterranean diet, rich in antioxidants and shown to improve menopausal symptoms. 

Exercise:  Regular physical activity is a potent medicine. Aim for at least 30 minutes of moderate-intensity exercise most days of the week. Weight training can help maintain muscle mass and bone density, both of which can decline with hormonal changes. Yoga and tai chi offer additional benefits for stress reduction and balance.

Sleep: Prioritize quality sleep! Aim for 7-8 hours of uninterrupted rest each night.  Develop a relaxing bedtime routine, create a cool and dark sleep environment, and limit screen time before bed. Sleep disruptions are a very common symptom as hormones change and the importance of good sleep hygiene practices becomes critical. 

Tending to the Emotional Landscape

Perimenopause and menopause can bring a rollercoaster of emotions. Mood swings, anxiety, and even depression are not uncommon. Here's how to nurture your emotional well-being:

Stress Management:  Identify and address your stress triggers. Practice relaxation techniques such as deep breathing, meditation, or mindfulness exercises. Explore activities you find enjoyable, whether it's reading a good book, spending time in nature, or connecting with loved ones. 

Talk Therapy:  If you're struggling, seeking professional support from a therapist can be incredibly valuable. Talking things through in a safe and confidential space can help you navigate emotional challenges.  

Support System:   We often speak about the importance of your tribe. Don't go it alone! Build a network of supportive friends and family who understand what you're going through.  Consider joining a support group specifically for women in perimenopause and menopause. 

Cultivating the Spiritual Connection

Perimenopause and menopause can be a time of profound personal transformation.  Here's how to tap into your inner wisdom and find meaning during this transition:

Mindfulness:  Practice mindfulness to stay present in the moment and appreciate the journey. Meditation and journaling can be powerful tools for self-reflection and growth.

Gratitude:  Actively cultivate an attitude of gratitude.  Focus on the things you're grateful for in your life, big or small. Gratitude has been shown to increase happiness and well-being.


Purpose:  Reconnect with your purpose in life. Explore your passions and interests. Consider volunteering or pursuing new hobbies that bring you joy and fulfillment.

Creating a Healthy Environment

The world around us can significantly impact our health and well-being. Here's how to create a supportive environment to thrive:

Toxins: Limit your exposure to environmental toxins found in cleaning products, personal care products, and even conventional produce. Opt for organic options as much as possible and choose natural cleaning solutions. A great place to research both what foods carry higher pesticide load (to avoid) as well as personal care products and cleaning solutions is the Environmental Working Group.

Sleep Sanctuary: Create a sleep sanctuary in your bedroom that is cool, dark, and quiet. This will help you achieve deeper, more restorative sleep. 

Nature Connection: Spending time in nature has a well-documented positive impact on our mental and physical health. Make time for regular walks in the park, hikes in the woods, or simply sitting outside and soaking up the sunshine.

Integrating Hormone Replacement Therapy (HRT) with the Holistic Approach  

The North American Menopause Society (NAMS) acknowledges that hormone therapy (HT) can be a valuable tool for managing some of the most bothersome symptoms of perimenopause and menopause.

According to NAMS, HRT is most beneficial for women under 60 or within 10 years of menopause onset. It is highly effective in alleviating hot flashes, night sweats, and vaginal dryness. Moreover, HRT can prevent bone loss and reduce the risk of osteoporosis-related fractures in postmenopausal women. However, they also emphasize the importance of a personalized approach, taking into account your individual health history, risk factors, and preferences.

While there have been negative past views on HRT, that perspective is continuing to change as is evidenced by NAMS as well as continuing research showing it is a safe and effective.

Understanding HRT Options

Estrogen Therapy:  This addresses symptoms like hot flashes, night sweats, vaginal dryness, and mood swings. It comes in various forms, including pills, patches, gels, creams, and vaginal rings.

Combined Estrogen and Progestin Therapy:  For women who still have their uterus, progestin is added to estrogen therapy to reduce the risk of uterine cancer. This combination therapy is also available in various forms.

The NAMS Recommendations on HRT

Individualized Approach: NAMS emphasizes that the decision to pursue HRT should be a collaborative one between you and your doctor. An integrative medicine physician will consider a holistic view of your unique health picture, including your medical history, family history of certain cancers, any past history or risk for blood clots and current medications. 

Lowest Effective Dose: The NAMS recommends using the lowest effective dose of HRT for the shortest duration necessary to control your symptoms. This approach helps to minimize potential risks while still achieving symptom relief.

Regular Monitoring: If you choose to pursue HRT, you'll need regular checkups with your healthcare provider to monitor any side effects and ensure the therapy remains safe and effective for you.

Combining HRT with an Integrative Medicine Approach

HRT can be a powerful tool, but it should be seen as one piece of the puzzle. By integrating HRT with the holistic approach outlined in the previous sections, you can create a comprehensive strategy for navigating perimenopause and menopause with vitality and well-being.

Focusing on a healthy diet, regular exercise, quality sleep, and stress management techniques can significantly enhance the effectiveness of HRT. While natural remedies have been proposed to assist with symptom relief during perimenopause and menopause, botanicals like evening primrose oil, black cohosh, or acupuncture, have been studied and show limited impact.

Maintaining emotional well-being through mindfulness practices, talk therapy, and a strong support system can further amplify the positive effects of HRT.

If you are experiencing symptoms related to perimenopause or menopause and would like to speak to an integrative medicine physician, contact us for a free 15-minute consultation.

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