What I Wish Women Knew About Perimenopause, as a Naturopathic Doctor

“I’m all on my own with this.”

And then it happened: the subtle, intimate caving-in of her shoulders, the glance downward. The slow sigh.

I waited.

Our eyes met again.

“Tell me more about what you’re experiencing.”

She was a single mom, 44, trying desperately not to crash and burn. Two kids with special needs, picky eaters, different schools with different support plans, full-time work that often leaked into her nights and weekends.

And a body that was starting to rebel.

Hot flashes, tossing and turning all night, exhaustion, and brain fog that would bring her to tears. She never said the part about the tears, but I saw them as she told me how she was feeling.

She felt different in her brain and her body, and she felt all alone.

As a naturopathic doctor, I hear a lot of stories about how women live, or sometimes just get by, in their bodies. My professional and personal experiences have taught me three essential things that I wish every woman knew about perimenopause:

Symptoms Are Your Body’s Cry For Self-Care

You can’t keep ignoring your own needs. 

If you’re a woman who’s gotten really good at putting yourself last, perimenopause demands that you rewrite your list. Your body’s needs will not be ignored. 

Self-care starts with the Foundations.

These are the basics, the habits that surprise exactly NO ONE when I say them. They’re foundational for a reason, yet they’re also the first things we women toss away when we enter the world.

Without the Foundations in place, no pill, patch or cream will work as well as it could. There is no pill that can erase sleep debt, crippling brain fog, or midlife ennui. At least, not one free of serious consequences.

The Foundations are:

1. A healthy diet (I love the Mediterranean diet: it’s a sustainable, evidence-backed diet for perimenopause, and it’s delicious too)

2.   Clean water (filter your water, and please avoid plastic!)
3.  Exercise: essential for physical and mental health
4.  Stress management: easier said than done, I know. I offer my patients potential solutions in two “buckets,” and ask them to prioritize one or the other: fun, and exercise.

• Fun: what can you do to have more fun in your life? Or, if fun is out of reach at the moment,
• Exercise: how can you move your body more? Exercise is a phenomenal stress reliever. Just find something you don’t hate, and if possible, find a buddy to enjoy it with.

5.  And sleep. This can be a tough one due to hormone imbalance, stress, aches and pains, and the complex interplay of midlife biology and brain chemistry. 

I find that exercise helps, so does protecting the hour or so before bed. Make it YOUR time. No more work, bills, or obligatory stuff. And a hot shower or bath, magnesium, and L-theanine can all help.

What do you WANT?

I’m not talking about food cravings, a few extra hours of sleep, or even fitting back into your skinny jeans without hating life (although these may be as far as you’ve gotten in answering the question! Believe me, I know).

Here’s what I mean: 

At a deep, soul level, what do you WANT? 

Now, maybe it is just better sleep or being able to fit back into your jeans without holding your stomach in. 

For our amazing, warrior mom above, it turns out, she wanted a partner. Her soul was claiming its readiness to meet the love of her life, but she was stuck in the swirling eddies of an overwhelming life plus hormone chaos, trapping her in a body and life she no longer recognized. 

So her deepest desire remained unconscious…until she and I created the space for her to voice it. Once we identified it, it became her North Star, her reason to dedicate time and energy to helping herself overcome perimenopausal symptoms and feel like herself again. 

She wanted to be ready to meet the man who deserved her, chaos and all.

Do YOU First

The oxygen mask metaphor applies. 

We can’t keep putting ourselves last on our list, and thinking that we’ll be okay. Not anymore. 

Perimenopause literally turns up the volume on our needs, so that we will finally recognize them as such: our body’s needs, not wants. 

That extra hour of sleep? Shelling out for the nice home water filter, or cooking more veggies and protein? Maybe paying extra for organic? Finding your way to an exercise class, or getting outside, a few times a week? 

These are no longer “nice-to-have;” now, they’re “need-to-have”.

But don’t worry: they don’t have to happen all at once. In fact, for 99.9% of us, they shouldn’t happen all at once. 

PERIMENOPAUSE IS AN INVITATION TO RADICAL SELF-CARE. 

It’s our body’s way of beckoning us toward deep, soul-awakening transformation, so that we are on track for the life we deeply desire, and deserve, to live.

But this is also true: HOW? 

How do we make this happen during one of the busiest times of our lives, when we may find ourselves caregiving for one or more generations of family, constantly extending ourselves for work, and maybe trying to discover who we are in a relationship that no longer feels like it used to?

The answer to this question reveals your next step forward: HOW. 

How, when I’m so exhausted and overwhelmed and under-motivated, how can I possibly make these changes? Or make any change? 

Don’t try to do it all at once. 

Pick one thing, and master it. 

What one habit will you choose to finally put yourself first? For example, I worked with a woman who was struggling with skin issues, brain fog, and lots of digestive problems, including gas, bloating and really uncomfortable constipation. 

She was also drinking about 8–10 ounces of water a day. Before things like exercise or sleep were even discussed, we got her drinking more water every day. This boosted her energy, got her digestion running again, and she started to notice her cyclic acne clear up! 

Sometimes the first step seems too simple. But I’ve seen time and time again that committing to it can bring massive improvements to how you look and feel. 

If you’re honest with yourself, you probably know the one thing that would move the needle the most for you. Commit to it, and watch your world change. Then, when it’s a non-negotiable habit, commit to the next.