Understanding Perimenopause and Menopause: A Naturopathic Perspective

By Dr. Karlee Tario ND

Perimenopause and menopause are not illnesses — they are powerful transitions.
But that doesn’t mean they always feel easy. Shifting hormones can leave many women wondering, "Is this still me?” 

We believe that understanding what’s happening in your body — and having a roadmap to navigate it — is key to thriving, not just surviving.

Let’s break it all down: What’s happening, what to watch for, how we approach testing, and how naturopathic medicine can help you feel empowered at every step.

What’s Really Happening to Your Hormones?

Perimenopause is the transitional phase before menopause, and it can begin as early as your late 30s or early 40s.

During perimenopause, hormones fluctuate unpredictably — especially estrogen and progesterone. Think of it like a hormonal rollercoaster: some months, your body produces plenty of hormones; other months, production is low or erratic. Ovulation becomes less consistent, and progesterone is often the first hormone to decline.

Eventually, estrogen levels also drop, leading to menopause, which is defined as 12 consecutive months without a menstrual period. On average, this happens around age 51.

Key changes include:

• Fluctuating, then declining estrogen

• Declining progesterone

• Shifts in testosterone, DHEA, thyroid hormones, and cortisol

These shifts affect every system in your body: brain, heart, bones, skin, metabolism, mood, and more.

Symptoms to Watch Out For

Every woman’s journey is different, but here are common symptoms that can signal perimenopause or menopause:

• Hot flashes and night sweats

• Sleep disturbances (difficulty falling asleep or staying asleep)

• Mood swings, anxiety, or feeling emotionally "off"

• Irregular periods (heavier, lighter, closer together, or skipping months)

• Brain fog or memory issues

• Fatigue that feels different than before

• Weight gain, especially around the midsection

• Hair thinning or changes in skin elasticity

• Decreased libido or vaginal dryness

• Increased urinary urgency or frequent UTIs

• Joint pain or muscle aches

• Breast tenderness or changes

• Heart palpitations

Not every woman will experience all of these symptoms — and they can vary in intensity. But if you feel like your body or mind has shifted and you're not sure why, it’s worth investigating.

The Naturopathic Approach: Why Testing Matters

In naturopathic medicine, we know that hormone health is deeply personal. Symptoms are clues — but testing gives us the full map.

Here’s a basic Hormone Testing Guide we recommend for women navigating perimenopause and menopause:

Sex Hormones

• Estradiol (E2): Main form of estrogen; too high or too low can drive symptoms.

• Progesterone: Important for sleep, mood, and cycle regulation.

• Testosterone: Impacts libido, strength, and mood.

• DHEA-S: A precursor hormone that supports resilience and vitality.

Thyroid Panel

• TSH, Free T3, Free T4, Anti-TPO, Anti-TG antibodies

• Thyroid function often shifts during menopause; symptoms of thyroid imbalance can mimic menopause symptoms.

Adrenal Health

• Cortisol (saliva or urine testing): Chronic stress can worsen hormone imbalance.

• DHEA: As noted, adrenal health is crucial to buffering hormone changes.

Blood Sugar and Metabolism

• Fasting Insulin and Glucose

• HbA1c (3-month blood sugar average)

• Lipid Panel (cholesterol and triglycerides)

Hormonal changes in menopause impact insulin sensitivity, cardiovascular health, and weight regulation.

Bone Health

• Vitamin D levels

• Calcium, magnesium, and parathyroid hormone if needed

Estrogen protects bones — when it drops, bone loss can speed up.

A Note on Testing Methods

You may hear about different testing options: blood (serum), saliva, or urine testing (DUTCH Test).
Each has strengths

• Blood (serum): Basic hormone levels, thyroid, lipids

• Saliva: Daily rhythm of cortisol, active hormone levels

• Urine (DUTCH): Full picture: hormones + metabolites + adrenal markers
  

Many naturopathic doctors blend several types of testing to get the clearest view.

Naturopathic Tools for Menopause Support

Once we understand your personal hormone map, the real magic happens:
We can create a tailored plan to support your transition naturally and safely.

This might include:

• Botanical Medicine (adaptogens for adrenal support, phytoestrogens for symptom relief)

• Targeted Nutrition (foods that balance blood sugar and support liver detox)

• Lifestyle Shifts (stress management, sleep optimization, strength training)

• Bioidentical Hormone Therapy (when appropriate)

• Mind-Body Medicine (breathwork, meditation, acupuncture)

We view menopause as an opportunity to tune into your body, replenish your reserves, and protect your future health.

Perimenopause and menopause aren’t just about hormones — they are about the whole woman.
By using symptom tracking, targeted hormone testing, and individualized care, you can move through this powerful life phase feeling informed, empowered, and resilient.