What if perimenopause and the transition to menopause could be seen by clients as a time to turn inward and prioritise themselves fully, to reinvent, renew, refocus, and take control of their health? In this blog, our Nutritional Therapist, Annie, will talk about ways to help support your clients on their journey.

Perimenopause or the ‘menopause transition’ is characterised by the decrease and fluctuation of hormones resulting in a wide range of symptoms such as insomnia, hot flushes, anxiety, depression, irritability, mood swings, vaginal dryness, loss of libido, urogenital infections, blood sugar imbalances, weight gain, brain fog and memory issues. These hormonal fluctuations can disrupt monoaminergic pathways, affect serotonergic and noradrenergic systems, and influence acetylcholine and dopamine signalling, all contributing to imbalanced emotional health. (Freeman, 2014) There is also a heightened risk of health issues such as osteoporosis, metabolic syndrome, and heart disease. (Gudise, 2024) However, as we explored in Understanding the "Second Spring" the changes that occur during perimenopause involve far more than merely “oestrogen deficiency.” Rather, this transition reflects a complex period of hormonal recalibration that interacts with multiple physiological systems.

Where to start?

Every client is unique, so taking a holistic view by assessing their nutrient intake, overall diet, stress levels, lifestyle habits, emotional well-being, sleep quality, and existing health conditions will help you shape the most appropriate and personalised plan. It is also important to consider their priorities. Clearer thinking, stronger muscles and bones, feeling more themselves, or all of the above?

Supporting hormones

Although we must take a whole system approach, supporting the shifting balance of hormones is central. During perimenopause oestrogen fluctuations contribute significantly to the potential symptoms. Phyto-oestrogens such as isoflavones, shatavari, rosemary or sage can reduce an increased oestrogen response or support a reduced one, by gently activating oestrogen receptors. This may help to reduce menopausal symptoms such as hot flushes, (Chen, 2015) risk of heart disease (Messina, 2014) and osteoporosis. (Wei, 2012)

Promoting effective detoxification of oestrogens, especially more potent and harmful oestrogen metabolites, can help to restore a more positive and healthful hormone balance. One more harmful form, 4-hydroxyoestrogen is detoxified via methylation, specifically using COMT enzyme, which is supported by folate, B12, B6 and magnesium. Another, 16-hydroxyoestrogen, is detoxified by sulphation, and supported by the amino acid cysteine, which may be supplemented as NAC. Broccoli extract, rich in sulforaphane and indole-3-carbinol, activates the Nrf2 pathway, promoting antioxidant defence (Saito, 2025) and also contributes to oestrogen balance by promoting the helpful 2-hydroxyoestrogen.

Essential fatty acids such as omega 6 Gamma linolenic-acid (GLA) also support hormonal balance and reduce inflammation by regulating prostaglandin levels, (Safdari, 2021) while omega-7 oil from sea buckthorn helps vaginal atrophy by reducing dryness associated with reductions in oestrogen. (Larmo, 2014) 

Supporting cognition

Women transitioning through menopause often report changes in cognitive function, such as memory problems. Certain herbs like rosemary enhance cognition, reducing brain fog. (Kosmopoulou, 2024) The key omega 3 essential fats EPA and DHA play critical roles in regulating synaptic plasticity, neurogenesis, and neuroinflammation, improving cognitive function and overall psychological health. (Azhar, 2026) Oestrogen facilitates endogenous conversion of dietary precursors into EPA and DHA, which declines significantly following the menopause. Interestingly, there is some evidence that omega-3 fatty acids can even increase ovarian reserve, potentially impacting the age of natural menopause, potentially due to their anti-inflammatory, antioxidant, blood flow-promoting, and mitochondrial health effects. (Minihane, 2025)

Lower levels of B6, B12, or folate can impact the conversion of homocysteine to methionine, leading to elevated homocysteine. This increases the risk of cognitive decline and neurodegenerative disease. (Lauer, 2022)

Supporting mental health

Hormonal shifts during perimenopause can also make the stress response more sensitive. As oestrogen and progesterone fluctuate, the hypothalamic-pituitary-adrenal axis (HPA) axis can become more reactive increasing release of hormones such as cortisol. This may manifest as a feeling of being overwhelmed, anxious, “wired but tired”, and result in insomnia. Oestrogen’s impact on neurotransmitters such as serotonin and dopamine can result in mood fluctuations.

Ensuring optimum levels of essential fats, including EPA and DHA, can improve psychological health on many levels, supporting sleep and reducing anxiety and depression. (Azhar, 2026) B vitamins, especially vitamin B6, folate and B12, magnesium, and zinc all play vital roles as cofactors in the synthesis of serotonin, dopamine, and GABA. Magnesium modulates the HPA axis to support nervous system regulation. Magnesium bisglycinate in particular is a great option for stress and sleep, as magnesium is involved in tryptophan, GABA, serotonin, and melatonin production, and glycine further promotes GABA for stress reduction. Lemon balm is a useful addition for promoting GABA, while saffron supports overall nerve health and promotes natural levels of serotonin and dopamine. (Savage, 2018) 

Alongside supplements, ensure you educate clients to support emotional well-being and mental health. Meditation, mindfulness, yoga, breathwork, nature exposure, micro pauses throughout the day, developing and maintaining boundaries, and taking time to rest without guilt are all useful tools. Exercise can be really helpful for relieving stress and anxiety. But a HIIT class might not be the best thing to bring them into balance! More mindful movement, such as yoga, which can be practiced at various levels of intensity, may be effective in reducing stress, insomnia, and menopausal symptoms, as well as improving quality of life. It has been shown to improve symptoms such as anxiety and depression and may also help reduce hot flushes and mood swings. (Nguyen, 2020) For sleep, avoid screens 2 hours before bed, keep the bedroom cool and dark, avoid alcohol, and caffeine at least 8 hours before bed.

Supporting energy levels

Oestrogen enhances insulin secretion and sensitivity, promoting glucose uptake. As oestrogen fluctuates or declines, the risk of blood sugar dysregulation, weight gain, and Type 2 diabetes increases. During this time, basal metabolic rate (BMR) decreases while appetite may increase, leading to higher calorie intake, weight gain, and visceral fat accumulation, thought to affect up to 60% of women during menopause. (Erdélyi, 2023) Unstable glucose levels may worsen fatigue, mood changes, cravings, and sleep disturbance.

To help, always focus on diet first, increasing protein and fibre in particular. No ‘max-ing’ required, just a gradual increase and focus on these two macronutrients, incorporating them into every meal. Not forgetting trusty plant-based protein sources such as organic tofu, tempeh, beans, and legumes, aiming for around 20-30g of protein per day from various sources. Nutrients that can help balance blood glucose include chromium, cinnamon, and magnesium to assist glycaemic metabolism and optimise insulin response. (Allen, 2013) Probiotics support glucose and lipid metabolism via SCFA production. Butyric acid inhibits inflammation and reduces lipid synthesis and may help protect against fatty liver changes. (Wang, 2025) Specific strains include Bifidobacterium longum and Lactobacillus plantarum.

To further support practical everyday energy levels, adaptogens such as shatavari help to boost stamina, while also acting on multiple levels, supporting hormonal balance, inflammation, cognition, mood, muscle health, hot flushes, insomnia, and immunity. (Gudise, 2024) It also influences monoaminergic neurotransmission, the HPA axis, and increase brain-derived neurotrophic factor (BDNF). (Singh 2023) Maca also supports energy, stamina, libido, and hormonal balance and has been found to ease anxiety, depression, hot flushes, night sweats, and sleep disturbances. (Meissner, 2006)

Supporting thyroid function

Thyroid health is an important consideration during the menopause, as symptoms of thyroid dysfunction can closely resemble those of menopause. This overlap can make it difficult for practitioners to determine where to start, especially if the client is taking medications or hormone replacement therapy (HRT). Higher oestrogen levels can increase the production of thyroid-binding globulin (TBG), reducing hormone availability. Ensuring adequate intake of nutrients that support thyroid function is recommended. (Mintziori, 2024) Iodine, selenium, zinc, iron, and vitamins A and D in particular play essential roles in thyroid function and metabolic regulation. Selenium supports conversion of T4 to T3 and acts as an antioxidant in thyroid tissue.

Supporting the gut

As hormonal shifts in perimenopause can also alter microbial diversity, a bidirectional relationship exists between gut function, hormonal balance, and mood, making gut health particularly relevant during this transition. (Wang, 2025) Certain gut bacteria also contribute to oestrogen regulation by producing β-glucuronidase, which deconjugates oestrogen metabolites, enabling recirculation – ‘the oestrobolome’. During perimenopause, impaired elimination or dysbiosis may increase reabsorption of metabolised oestrogen. Given the fluctuating and sometimes elevated oestrogen levels characteristic of this stage, this may prolong exposure relative to progesterone (‘relative oestrogen dominance’), potentially exacerbating PMS-like changes, bloating, and irregular cycles. In contrast, a balanced microbiome and regular bowel movements support effective hormone elimination and reduce reabsorption.

Supporting connective tissue

Oestrogen is anabolic and protective of connective tissue, including skin, bones and joints, so fluctuating and diminishing levels of oestrogen, affect structure of key organs. Ensure adequate protein intake and type I collagen to support skin, gut, bone matrix and muscle mass, alongside regular resistance and impact training to stimulate bone remodelling. When considering bone support, look beyond calcium to include magnesium, vitamin D, vitamin K2, zinc, and antioxidants that enhance collagen. Probiotics and prebiotics are increasingly studied for their role in bone health. Certain strains, such as Prevotella histicola, may help prevent oestrogen deficiency–related bone loss via the gut–bone axis. Prebiotics, including inulin-type fibres, promote both microbial diversity and SCFAs, which enhance mineral absorption and may help reduce bone loss. (Wang, 2025)

So, what would this mean in practice?

Supplements to recommend could include the following:

A high-quality multivitamin (such as Menopause Multi, or Women’s Wholefood Multi if perimenopausal) can be a helpful starting point, supporting optimal levels of key nutrients such as B vitamins, vitamin D, and zinc, as well as targeted support with NAC, antioxidants including lutein and resveratrol, and herbs such as sage and rosemary. This provides optimum support for multiple areas including energy, neurotransmitter function, hormonal balance, and skin and bone support. Add further foundational support in the form of an Omega 3 supplement. (Omega 3 Vegan or Fish Oil) or an omega 3/6 combination (Omega Balance). And support the gut using a targeted high strength probiotic (Recovery Biotic).

Where additional support for hormones is needed, perhaps where symptoms are particularly severe, consider additional phytoestrogens in Menopause Support or Perimenopause Complex, which also adds adaptogenic herbs to support mental and physical energy.

Specific issues with stress or poor sleep can be helped with Calm Support (with lemon balm and theanine) and/or Magnesium Bisglycinate. Low mood and motivation may benefit from 5HTP Plus (including saffron and 5HTP). Fluctuating Blood Glucose issues can be helped with Blood Glucose Support, alongside dietary changes. Extra connective tissue structural support in general can be provided with Marine Collagen (type I collagen) and/or Bone Support

Supporting your clients through perimenopause and beyond requires a whole-systems perspective, recognising that hormonal shifts influence far more than reproductive health, and looking at the interactions between hormonal changes and other systems. By addressing diet, lifestyle, and recommending targeted nutritional support, practitioners can help optimise physiological and physical health, allowing clients to navigate this transition with greater stability, vitality, and long-term health in mind.

References

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Gudise, V. S., et al (2024). Efficacy and safety of shatavari root extract for the management of menopausal symptoms: A double-blind, multicenter, randomized controlled trial. Cureus, 16(4), e57879.

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All of our blogs are written by our team of expert Nutritional Therapists. If you have questions regarding the topics that have been raised, or any other health matters, please do contact them using the details below:

nutrition@cytoplan.co.uk

01684 310099