Perimenopause Without HRT: A Root Cause Guide from a Functional Nutritionist

A Root Cause Approach to Balancing Hormones Naturally

Perimenopause symptoms like brain fog, mood swings, hot flashes, stubborn weight gain, and fatigue aren’t just “Welp! I guess this is 30!” or a sentence to pain and suffering just because you've hit a certain season in life. Symptoms are always messages from the body. I love to help women understand what's going on in their body and uncover the root causes of their symptoms and guide them through perimenopause with grace, clarity, nourishment, and real whole-body support, without jumping straight to hormone replacement therapy (HRT).

Here's the "Understand What's Going On" in Perimenopause Part:

Perimenopause is the transitional phase before menopause that typically starts in a woman's late 30s to early 40s. It's a frustrating time in her life that she feels out of place in her body because her hormone levels (especially estrogen and progesterone) start to fluctuate and it feels like everything changes.

Common Symptoms of Perimenopause Include:

• Fatigue and brain fog

• Weight gain (especially around the belly)

• Mood swings and anxiety

• Irregular or heavy periods

• Low libido

• Poor sleep

• Hot flashes or night sweats

Yes, hormones are shifting and a woman's life changes in this stage, but these symptoms are signals of deeper imbalances in the body. To jump straight to treating the hormones without tending to what's causing them would be a disservice. Instead of treating symptoms in isolation, we ask what systems are overwhelmed or undernourished, and what the body needs to function better.

Root Causes Behind Perimenopause Symptoms

1. HPA Axis Dysfunction (Stress + Adrenal Fatigue)

Your brain and adrenals manage stress and hormone production. When this system is overworked, symptoms like insomnia, irritability, and cortisol belly show up.

2. Blood Sugar Imbalance

Estrogen affects insulin sensitivity. As levels shift, you may experience blood sugar crashes, cravings, or energy dips, even with “healthy” eating.

3. Poor Detoxification

Your liver detoxifies used hormones. If it’s sluggish, estrogen metabolites recirculate, contributing to PMS, inflammation, and estrogen dominance.

4. Gut Health Imbalance

The estrobolome (the collection of gut bacteria that regulates how much estrogen is reabsorbed vs. eliminated) becomes critical during perimenopause. Constipation, bloating, or dysbiosis = hormone chaos.

How to Support Perimenopause Naturally

1. Prioritize Blood Sugar Balance

Balanced blood sugar stabilizes mood, energy, and weight.

• Eat PFF meals (protein, fat, fiber-filled carbs)

• Avoid skipping meals to maintain natural gentle rise and fall in blood sugar

• Limit caffeine on an empty stomach

Tip: Add minerals like magnesium or try berberine to improve insulin sensitivity. I have functional tests that can tell us more and give us a better idea of how where you need support.

2. Support Your Stress Response (HPA Axis)

Perimenopause often reveals long-standing stress patterns. During your reproductive years, your ovaries produce most of your estrogen and progesterone. As you enter perimenopause, your ovarian hormone production starts to decline, and the adrenal glands (part of the HPA axis) have to pick up the slack, especially in producing precursor hormones like DHEA that can convert into estrogen and testosterone.

If your adrenals are already taxed from years (or decades) of chronic stress, undernourishment (eat less, lose more, right?) or poor sleep, they may not be able to compensate. This is why perimenopause symptoms often “flare up” or worsen in women who’ve been running on empty for years, even when they seemed perfectly fine before.

Think of it like this:

➡️ During your 20s and 30s, your body buffered the effects of stress with robust hormone production. ➡️ In perimenopause, that buffer starts shrinking and long-standing imbalances actually show themselves. Here's how you can support your body's stress response:

• Use breathwork or 4-7-8 breathing

• Walk daily in nature

• Consider adrenal adaptogens like holy basil or rhodiola

  

3. Nourish the Liver for Hormone Detox

Your liver needs nutrient support to clear estrogen efficiently. Phase I and Phase II Detox happens in the liver, where used or excess estrogen is converted into metabolites, and packaged into forms your body can safely eliminate through the gut and urine. When the liver is under-functioning due to nutrient deficiencies, toxin overload, inflammation, or alcohol/caffeine burden, it can’t keep up with estrogen clearance, which leads to:

• Estrogen metabolites building up in the bloodstream

• Recirculation of estrogens through the enterohepatic loop (especially if you're constipated)

• Increased risk of estrogen dominance symptoms

Here's how you can support the liver in this:

• Eat cruciferous veggies (broccoli, arugula, cabbage)

• Use castor oil packs

• Try lemon water or a supplement with calcium-D-glucarate or possibly DIM if symptoms of estrogen dominance are present
  

4. Rebuild Gut Health

A sluggish gut can slow hormone clearance. When the estrobolome is out of balance (due to dysbiosis, constipation, antibiotics, poor diet, etc.), beta-glucuronidase activity increases, leading to symptoms of estrogen dominance, even when your production is low or declining in perimenopause. Here's how to support the gut in that:

• Aim for 1–2 daily bowel movements

• Eat fermented foods

• Consider probiotics and L-glutamine if symptoms persist
  

Here are the Best Supplements to Support Perimenopause Without HRT

These supplements are safe for most women and can provide targeted support for perimenopause symptoms naturally.

1. DIM-Evail Supports Phase I estrogen metabolism, helping to convert estrogen into protective metabolites. Especially helpful for women with signs of estrogen dominance like PMS, breast tenderness, or heavy cycles.

2. LV-GB Complex Promotes liver and gallbladder function to enhance bile flow and Phase II detoxification. Supports the elimination of used hormones and reduces hormonal buildup.

3. Adaptogen Tonic A blend of adrenal-supportive herbs like rhodiola, ashwagandha, and holy basil. Helps regulate the HPA axis, improve energy, and reduce the effects of chronic stress on hormone balance.

4. Berberine Synergy Balances blood sugar, improves insulin sensitivity, and reduces cravings. Also supports gut health and inflammation, which are both key players in hormone regulation.

5. FemGuard+Balance Comprehensive hormone support for perimenopausal and cycling women.Includes: Chaste tree (Vitex) to support progesterone and regulate cycles, Calcium-D-glucarate for liver Phase II estrogen detox, Vitamin B6 for neurotransmitter and hormone support, DIM, resveratrol, green tea extract, broccoli seed for antioxidant and estrogen-balancing effects

6. GABA-T SAP Supports GABA production for improved sleep, anxiety relief, and nervous system balance. Helpful for those experiencing mood swings, insomnia, or stress-driven fatigue. I created a freebie below with the brands and supplements I recommend, discounted for you! Let's talk through these before you start taking them, so we know you're supporting your body and not overburdening it with supplements you don't need! Please know that these supplements are blanketed for most women, and to know where your body needs support, we will need to dig deeper into your unique symptoms and situation!

✅ Click here to check out the supplements >>

Want to Go Deeper?

If you feel like your body is stuck in survival mode or you're overwhelmed by your perimenopause symptoms, it’s time for a root-cause assessment. We can put all of your symptoms together and get a whole- person big picture of how we can support your body with whole foods and possible functional testing if necessary, like:

• Hormone panels (DUTCH)

• GI-MAP for gut health + estrogen clearance

• HTMA for mineral balance and adrenal insight
  

Head to the homepage and click the "Get in Touch" button or scroll down to the contact form at the bottom of the page, answer a few questions about your current health needs and I will be in touch! ✅ This link will take you there >>

You weren’t meant to suffer through perimenopause and you don’t have to just tough it out. With the right nutrition and support, you can feel clear, energized, and at home in your body again. Don't just roll over and take it, friend!!! Stand up against the norm and take control of your body and your health!