Understanding Menopause and Perimenopause:

A Comprehensive Guide to Hormones, Health, and Healing

Menopause is a powerful biological transition that every woman will experience, yet it’s one of the most misunderstood and under-discussed phases of life. Often wrapped in stigma or brushed off as simply “getting older,” the truth is far more complex and empowering. To truly thrive during this chapter, we must understand what’s happening beneath the surface—starting with hormones, brain chemistry, and lifestyle.

The Phases of the Menstrual Cycle: A Hormonal Symphony

Before diving into perimenopause and menopause, it’s essential to understand what happens during a normal menstrual cycle.

The normal menstrual cycle is a monthly hormonal rhythm that prepares a woman’s body for pregnancy and is a vital sign of overall health. It typically lasts between 25 to 35 days and is divided into four key phases: the menstrual, follicular, ovulation, and luteal phases. At the start of the cycle, both estrogen and progesterone are low, triggering menstruation. As the follicular phase progresses, estrogen rises, helping to grow the uterine lining and mature an egg. Ovulation occurs mid-cycle, marked by a surge in luteinizing hormone (LH). In the luteal phase, progesterone rises to support potential pregnancy. If fertilization doesn’t occur, hormone levels drop and the cycle begins again.

The Four Phases:

Menstrual Phase (Day 1–5)
- Estrogen and progesterone are low.
- The uterine lining sheds.
- Energy may be lower; rest is important.
Follicular Phase (Day 1–13, overlaps with menstruation)
- Estrogen rises to prepare the body for ovulation.
- Follicle-stimulating hormone (FSH) helps mature follicles.
- Energy increases; this is a good time for strength training and creative work.
Ovulation (Around Day 14)
- A surge in luteinizing hormone (LH) triggers egg release.
- Estrogen peaks, and testosterone rises slightly.
- Libido is highest; social energy is strong.
Luteal Phase (Day 15–28)
- Progesterone rises to prepare for a possible pregnancy.
- Estrogen dips slightly then rises again.
- If no pregnancy occurs, both drop, triggering menstruation.

What Happens During Perimenopause?

Perimenopause is the 5–10 years leading up to menopause. While menopause is defined as 12 consecutive months without a period, perimenopause is when the hormonal fluctuations begin.

Menopause is the natural biological transition marking the end of a woman’s reproductive years. It is officially diagnosed after 12 consecutive months without a menstrual period, typically occurring between ages 45 and 55. During this time, the ovaries significantly reduce the production of key hormones like estrogen and progesterone, which can lead to a variety of physical and emotional changes. While menopause is a normal part of aging, it often comes with symptoms such as hot flashes, mood swings, sleep disturbances, and weight changes. Understanding what’s happening hormonally can empower women to support their bodies through this phase with confidence and care.

Hormonal Shifts During Perimenopause:

Estrogen: Becomes erratic—some days too high, some days too low.
Progesterone: Begins a gradual decline, often more consistently than estrogen.
Testosterone and DHEA: Slowly decline, impacting libido and muscle mass.
Cortisol: May increase if stress is not managed, exacerbating symptoms.

Common Symptoms of Perimenopause:

Irregular periods
Mood swings or increased anxiety
Sleep disturbances
Brain fog
Low libido
Weight gain (especially around the midsection)
Hot flashes or night sweats
Breast tenderness
Joint pain
Vaginal dryness
Increased sensitivity to stress

The Role of the Adrenal Glands and Hormone Production

Once the ovaries wind down hormone production, the adrenal glands—tiny glands that sit on top of your kidneys—step in to help fill the gap. They produce small amounts of estrogen, progesterone, and DHEA. However, they primarily regulate cortisol, your body’s primary stress hormone.

During menopause, the adrenal glands play a crucial backup role in hormone production as the ovaries gradually stop producing estrogen, progesterone, and testosterone. These small but powerful glands, located above the kidneys, are responsible for producing stress hormones like cortisol, as well as small amounts of sex hormones. When ovarian hormone production declines, the body relies more heavily on the adrenals to fill in the gap—especially for estrogen and DHEA. However, if the adrenals are already overworked due to chronic stress, poor sleep, or poor nutrition, they may struggle to keep up, leading to increased fatigue, mood swings, and other menopausal symptoms. Supporting adrenal health during this transition is key for maintaining hormonal balance and overall well-being.

Why We Still Need Hormones Post-Menopause:

Hormones like estrogen, progesterone, and testosterone continue to serve critical roles:

Estrogen: Protects bones, skin elasticity, brain health, and heart function.
Progesterone: Calming, supports sleep, and balances estrogen.
Testosterone: Supports mood, energy, libido, and muscle mass.

If the adrenals are overworked—due to chronic stress, under-eating, or poor sleep—they won’t be able to make enough of these key hormones.

Cortisol and Cortisone: Stress and Hormone Balance

Cortisol and cortisone play a significant role in how women experience menopause, especially when it comes to stress, energy, and hormone balance. Cortisol is your body’s main stress hormone, produced by the adrenal glands. It helps regulate energy, blood sugar, inflammation, and your sleep-wake cycle. During menopause, as estrogen and progesterone decline, the body becomes more sensitive to stress—and cortisol can easily become imbalanced. Chronic stress or poor lifestyle habits can cause cortisol to rise too high or drop too low, leading to symptoms like fatigue, anxiety, weight gain (especially around the midsection), and poor sleep.

Cortisone is the inactive form of cortisol. The body converts cortisol to cortisone and back again as a way to regulate and protect tissues from overexposure to stress hormones. In menopause, an imbalance in this conversion can further affect energy levels, immune function, and inflammation.

Maintaining balanced cortisol and cortisone levels is crucial during menopause because these hormones influence how well your body adapts to the loss of ovarian hormone production. A healthy stress response, supported by sleep, blood sugar balance, and mindfulness practices, can make the transition through menopause smoother and more manageable.

Cortisol:

Produced by the adrenal glands.
Helps you wake up, manage stress, regulate inflammation, and stabilize blood sugar.
Should follow a daily pattern: high in the morning, slowly tapering off throughout the day.

Cortisone:

An inactive form of cortisol.
Your body can convert cortisol to cortisone to regulate levels and protect tissues from overexposure to stress hormones.

When cortisol is too high or too low, it throws off all other hormones. It can lead to:

Belly fat
Blood sugar imbalances
Poor sleep
Low immunity
Anxiety or burnout

Circadian Rhythm: The Key to Hormonal Harmony

Your circadian rhythm is your internal 24-hour clock. It regulates sleep-wake cycles, hormone production, and metabolism.

Your circadian rhythm is your body’s internal 24-hour clock that regulates sleep, energy, hormone release, digestion, and even mood. It’s closely tied to light and darkness—helping you feel alert in the morning and sleepy at night. This rhythm plays a critical role in hormone balance, especially during menopause. Cortisol, your primary stress hormone, should follow a circadian pattern—rising in the morning to wake you up and gradually decreasing throughout the day. When this rhythm is disrupted—by irregular sleep, late-night screen time, or chronic stress—it can throw off cortisol, melatonin, insulin, and even estrogen. Supporting a healthy circadian rhythm with consistent sleep/wake times, morning sunlight, and calming evening routines can help regulate hormones, improve energy, and reduce menopausal symptoms.

A Healthy Circadian Rhythm Supports:

Morning cortisol production (to feel alert)
Evening melatonin release (to help you sleep)
Proper insulin and estrogen balance
Energy throughout the day

Disrupted Rhythms Can Lead To:

Cortisol imbalances
Hormonal irregularities
Insomnia
Fatigue
Mood swings

Holistic Lifestyle Practices to Support Hormones During Menopause

Supporting your hormones through lifestyle changes is powerful and sustainable.

Holistic lifestyle practices are essential during menopause to support the body through hormonal changes and help ease symptoms naturally. Focusing on key areas like nutrition, movement, sleep, stress reduction, and mindset can create a strong foundation for hormone balance. Eating a whole-food, nutrient-dense diet with plenty of protein, healthy fats, and fiber supports blood sugar stability and estrogen metabolism. Regular movement—especially strength training—helps maintain bone density, muscle mass, and mood. Prioritizing restful sleep and creating a calming evening routine supports cortisol and melatonin balance. Stress management practices like breathwork, meditation, and journaling help calm the nervous system and ease anxiety. These simple, consistent habits can make a powerful difference in how women feel through menopause and beyond.

1. Diet

Focus on protein at every meal to preserve muscle mass and stabilize blood sugar.
Add healthy fats (avocado, olive oil, nuts) for hormone production.
Include fiber from veggies, fruits, and whole grains to support estrogen detox.
Limit processed foods, sugar, and alcohol which can inflame and disrupt hormones.

2. Rest

Prioritize 7–9 hours of quality sleep.
Create a wind-down routine with low lights, no screens, and calming music or reading.
Support your natural melatonin with magnesium and a consistent sleep schedule.

3. Exercise

Strength training 2–3x/week helps maintain muscle and bone density.
Walking and light cardio improve insulin sensitivity.
Yoga and stretching reduce cortisol and support flexibility.

4. Stress Reduction

Try meditation, breathwork, or journaling.
Set boundaries and protect your energy.
Spend time in nature and connect with others.

5. Gut Health

Gut bacteria help metabolize and excrete estrogen.
Support gut health with fermented foods, fiber, and digestive enzymes if needed.

Supplements That Can Support Menopause and Hormone Balance

Supplements can be a powerful tool during menopause to support hormone balance, reduce symptoms, and fill nutritional gaps. As estrogen, progesterone, and testosterone decline, the body may benefit from targeted support. Magnesium glycinate promotes relaxation and sleep, while B-complex vitamins support energy, mood, and hormone metabolism. Vitamin D3 with K2 is crucial for bone health and immune function. Omega-3s help reduce inflammation and support brain health. Adaptogenic herbs like ashwagandha and rhodiola can regulate cortisol and improve resilience to stress. DIM (diindolylmethane) supports estrogen detox, and probiotics enhance gut health and estrogen metabolism. When used alongside a balanced lifestyle, these supplements can ease the transition through menopause and help women feel more vibrant and supported.

Always consult a practitioner before starting supplements, but here are some commonly helpful ones:

Magnesium Glycinate: Supports relaxation, sleep, and progesterone production.
B-Complex: Essential for energy, estrogen metabolism, and stress support.
Vitamin D3 + K2: Bone health, mood, and immune support.
Omega-3s (EPA/DHA): Anti-inflammatory, supports brain health and hormone production.
Ashwagandha: Adaptogenic herb that helps regulate cortisol and reduce anxiety.
Rhodiola: Another adaptogen that supports energy and stamina.
DIM (Diindolylmethane): Helps metabolize excess estrogen.
Probiotics: Support gut and immune health, enhance estrogen detox.
DHEA (only under supervision): Can support libido, energy, and mood in postmenopausal women with low levels.

The DUTCH Plus Lab: A Deeper Look at Your Hormones

The DUTCH Plus (Dried Urine Test for Comprehensive Hormones) is a powerful tool to assess hormonal imbalances.

The DUTCH Plus lab (Dried Urine Test for Comprehensive Hormones) is a cutting-edge tool that provides an in-depth look at your hormone health, particularly valuable during perimenopause and menopause. Unlike standard blood tests, the DUTCH test captures hormone fluctuations throughout the day using dried urine and saliva samples collected at home. It measures sex hormones like estrogen, progesterone, and testosterone, along with adrenal hormones like cortisol and cortisone, giving insight into your stress response and daily cortisol rhythm. It also assesses hormone metabolites, melatonin levels, and markers related to dopamine and serotonin. This comprehensive view helps uncover root causes of symptoms like fatigue, anxiety, weight gain, and sleep issues. With this data, a practitioner can create a targeted plan to rebalance your hormones and support your overall health more effectively.

What It Tests:

Estrogen, progesterone, testosterone
DHEA and its metabolites
Cortisol and cortisone (plus their rhythm throughout the day)
Melatonin
Organic acids like dopamine and serotonin markers
Estrogen metabolism and methylation

How It Works:

Easy, at-home test using dried urine and saliva samples.
Collected throughout the day to capture hormone rhythms and patterns.
Results are interpreted by trained practitioners to create personalized action plans.

This lab provides insight that blood work often misses, especially the connection between stress and sex hormones.

How Functional Nutritionists Can Help

A Functional Diagnostic Nutritionist approaches menopause from a root-cause perspective.

A Functional Diagnostic Nutrition Practitioner (FDN-P) can be a game-changer for menopausal women by addressing the root causes of hormonal imbalances rather than just managing symptoms. Through advanced lab testing like the DUTCH Plus, an FDN-P can assess how well the body is producing, metabolizing, and detoxifying hormones, as well as evaluate adrenal function, neurotransmitters, and gut health. With this personalized data, they create a customized plan that includes targeted nutrition, supplements, stress management, sleep optimization, and lifestyle shifts to support the body’s natural healing processes. Unlike conventional approaches that often rely on medications alone, an FDN-P takes a holistic, whole-body approach to help women feel balanced, energized, and in control of their health through menopause and beyond.

Differences from Western Medicine:

Western medicine: May offer symptom relief (HRT, antidepressants), but rarely investigates why the imbalance exists.
Functional approach: Looks at gut health, stress, nutrient deficiencies, and lifestyle to create a personalized plan.

Through lab testing like the DUTCH Plus, a nutritionist can:

Spot early imbalances before symptoms worsen
Guide supplementation and nutrition based on your specific needs
Support you with sustainable, long-term strategies
Empower you to take control of your health

Real-Life Testimonials

Every woman’s menopause journey is unique, and sometimes the most powerful motivation comes from hearing real stories of transformation. These testimonials highlight women who struggled with common menopausal symptoms—like anxiety, weight gain, mood swings, and poor sleep—and found clarity and relief through functional lab testing and personalized support. Their experiences show just how impactful it can be to dig deeper, understand what’s truly happening in the body, and take actionable steps toward balance. If you’ve been feeling stuck, frustrated, or unheard, these stories may inspire you to take that first step toward healing and feeling like yourself again.

1. Jennifer, 48 – Anxiety, Weight Gain, and Brain Fog

“I was feeling anxious every day, snapping at my family, gaining weight despite eating clean, and couldn’t think clearly. I thought I was just ‘losing it.’ The DUTCH Plus test showed my cortisol was flatlined, and I wasn’t producing enough estrogen. With support from a functional nutritionist, I changed my workouts, added B vitamins, and started Ashwagandha. Three months later, my anxiety is down, and I’ve lost 10 pounds without extreme dieting.”

2. Carla, 52 – Depression and Insomnia

“I kept waking up at 2 a.m. every night and felt exhausted all day. I was moody and borderline depressed. My doctor said it was ‘normal menopause.’ But when I did the DUTCH test, I learned my nighttime cortisol was too high and serotonin was low. I added magnesium, changed my bedtime routine, and began targeted amino acids. Within a few weeks, I started sleeping through the night and feeling like myself again.”

3. Amanda, 46 – Low Libido and Fatigue

“I felt disconnected from my body—no energy, no sex drive, and no motivation. My hormones were all over the place. The DUTCH Plus test revealed low DHEA and poor estrogen clearance. With a customized plan that included strength training, liver support, and DIM, my energy came back. I feel empowered knowing what’s happening and how to support it naturally.”

Final Thoughts: You Deserve to Feel Good

Menopause isn’t the end—it’s a new beginning. You don’t have to settle for fatigue, mood swings, or weight gain. With the right tools, knowledge, and support, you can feel strong, vibrant, and balanced.

If you’re tired of guessing, if you’re ready to understand your body and feel good again, testing is a powerful first step. The DUTCH Plus test gives you insight, and a functional nutritionist helps you turn that insight into action.