Perimenopause is one of the most natural and powerful transitions in a woman’s life. It marks the gradual shift from the reproductive years toward menopause — a time when the body begins to recalibrate its hormonal rhythms, preparing for a new season of balance and wisdom. While it’s often framed as something to fear or “get through,” this chapter can instead become a time to tune in, nourish deeply, and reconnect with what your body truly needs.

During perimenopause, oestrogen and progesterone levels naturally fluctuate, which can bring changes in mood, sleep, cycles, skin, and energy. But these shifts aren’t signs of decline — they’re invitations to listen more closely. Your body is asking for support, stability, and space to adapt. When you honour those signals with nourishment, movement, rest, and mindful living, you create the foundation for long-term vitality and graceful ageing.

Rather than dreading the transition, think of perimenopause as an awakening — a call to refine your health, reset your priorities, and embrace your strength in a new form. With the right mindset and practical tools, this stage can be a time of renewal, empowerment, and profound self-connection.

Perimenopause isn’t the beginning of the end — it’s the beginning of becoming more you.

When we approach perimenopause through the lens of functional and nutritional medicine, we shift from symptom management to body optimisation. Instead of waiting for imbalances to appear, we can prepare the terrain — ensuring our hormones, nervous system, gut, and metabolic health are all supported as we transition. This approach recognises that your body already knows how to move through perimenopause; it simply needs the right environment to do so with ease and resilience.

Functional Medicine Testing and Assessment

Functional medicine practitioners take a whole-systems view of the body, seeking to understand why symptoms arise rather than merely addressing them. Recommended assessments may include:

Comprehensive hormone panels (serum, saliva, or urine) to evaluate oestrogen, progesterone, testosterone, and adrenal health.
Adrenal and cortisol profiles to understand stress patterns and energy regulation.
Full thyroid panel (TSH, free T4, free T3, reverse T3, antibodies) to identify subtle thyroid changes that may mimic perimenopausal symptoms.
Metabolic and insulin testing to assess blood sugar balance and cardiovascular risk.
Micronutrient analysis to detect deficiencies in vitamin D, B vitamins, magnesium, zinc, selenium and essential fatty acids.
Bone health and vitamin D status to establish a baseline for long-term skeletal strength.
Comprehensive stool and gut microbiome testing to assess the ‘estrobolome’ – the gut bacteria that influence oestrogen metabolism.
Liver and detoxification markers to ensure hormones are being efficiently cleared from the body.

These investigations provide a personalised blueprint, guiding targeted nutritional and herbal support.

Foundational Nutritional Support

A strong foundation is built on optimal nutrition and key micronutrients that sustain energy, hormone production, and cellular repair. Core supports often include:

Magnesium – calms the nervous system, supports sleep and reduces muscle tension.
Vitamin D (with K2) – vital for immune, bone, and mood health.
B-complex vitamins – particularly B6, B12 and folate, which support neurotransmitter balance and hormone metabolism.
Zinc and selenium – assist thyroid function and antioxidant defence.
Omega-3 fatty acids – reduce inflammation and support mood, cardiovascular and brain health.
Probiotics and prebiotics – enhance gut health and support healthy hormone clearance.
Calcium (preferably through food) – supports bone density when combined with weight-bearing movement.

Herbal and Botanical Medicine

Herbal supports can gently restore hormonal balance, ease perimenopausal symptoms, and build resilience during times of stress. Commonly used herbs include:

Black cohosh for hot flushes and temperature regulation.
Chaste tree (Vitex) to support progesterone production and menstrual regularity.
Dong quai and red clover for oestrogenic balance and circulation.
Adaptogens such as ashwagandha, rhodiola and eleuthero to modulate stress responses and stabilise energy.
Motherwort for anxiety and palpitations.
Evening primrose oil and flaxseed oil for hormonal balance and skin health.
Calcium D-glucarate and DIM (Diindolylmethane) to promote healthy oestrogen metabolism.

Herbal protocols should be individualised, as the body’s needs evolve throughout perimenopause. Quality, dosing, and duration all matter – this is where working with a qualified practitioner can make a real difference.

Lifestyle Medicine for Perimenopause

Lifestyle medicine forms the foundation of hormonal harmony. It anchors the body in rhythm, stability, and vitality.

Nutrition and Eating Patterns

Prioritise whole, unprocessed foods and a Mediterranean-style diet rich in vegetables, fruits, legumes, lean proteins and healthy fats.
Balance blood sugar by combining protein, fibre, and good fats in each meal.
Support oestrogen metabolism with cruciferous vegetables such as broccoli, kale, and Brussels sprouts.
Increase dietary fibre to aid hormone detoxification and gut balance.
Limit processed foods, refined sugars, caffeine, and alcohol, which can heighten inflammation and vasomotor symptoms.
Include colourful plant foods and herbs (turmeric, ginger, berries) for antioxidant support.

Movement and Exercise

Engage in resistance and strength training to preserve muscle and bone density.
Include weight-bearing activities such as walking, dancing, or hiking for bone health.
Maintain cardiovascular exercise to support heart and metabolic function.
Add yoga, Pilates, and mobility work to enhance flexibility, posture, and stress relief.
Avoid overtraining; allow time for rest and recovery.

Sleep and Circadian Health

Create consistent sleep routines with a dark, cool bedroom environment.
Limit screens and bright light exposure in the evening.
Address night sweats through breathable fabrics and room cooling strategies.
Seek morning sunlight to reinforce healthy circadian rhythms.

Stress Regulation and Nervous System Support

Integrate daily mindfulness, breathing exercises, or meditation.
Use heart rate variability (HRV) or gentle yoga to improve nervous system resilience.
Make time for creativity, stillness, and restorative practices.
Stay socially connected – community and purpose profoundly affect hormonal health.

Environmental and Detoxification Support

Reduce exposure to endocrine-disrupting chemicals by choosing clean skincare, household, and food-storage products.
Filter water and ventilate living spaces to lower chemical load.
Support natural detoxification with cruciferous vegetables, adequate hydration, and regular sweating through exercise or sauna use.

Integrating it all…

Functional and nutritional medicine view perimenopause as an opportunity to reclaim health, not merely manage decline. By assessing the body comprehensively, replenishing what’s missing, and restoring what’s out of balance, you create the conditions for smooth transition and renewed vitality.

When we work with the body rather than against it, perimenopause becomes a period of profound empowerment — a time to embody wisdom, strength, and self-understanding at a deeper level than ever before.

Your body is not failing you — it’s evolving. Support it, listen to it, and it will serve you beautifully in this next chapter.

Honouring the wisdom within, empowering your journey to thriving health.
— Dr Ashleigh Bond