Not long after you blew the candles out for your 40^th birthday cake, you likely started to notice some subtle shifts in how you were feeling. Maybe you started feeling a bit more irritable, anxious, or sluggish. Perhaps your menstrual cycle started to alter. Or maybe your libido took a hit. While menopause occurs around 50 years of age for most women, it’s possible to start experiencing the hormonal shifts of perimenopause –  the period of time that leads up to the time your menstrual cycle stops for good – in their early 40s.

Here are some of the most common questions that people have around perimenopause, and what can be done to help support their hormones naturally.

What are the symptoms of perimenopause?

Perimenopause is a time of hormonal fluctuations, and with this many symptoms can occur. Some of the most common symptoms that women experience sleep disturbances, mood swings, reduced stress tolerance, lowered libido, hot flushes, menstrual irregularity, changes in menstrual flow (may be lighter or heavier than usual, sometimes with significant increases), bloating, brain fog, joint or muscle aches, hayfever, itchy ears, fatigue, vaginal dryness, increased tendency to thrush or BV, and headaches/migraines.

Why do women get perimenopausal symptoms?

Unlike after menopause, when hormones are at a lower state and symptoms can occur because of these low levels, in perimenopause symptoms can be caused by the fluctuations of oestrogen and the gradual decline of progesterone. These hormonal shifts can cause the adrenal response to stress to be affected, which also means that stress can be harder to deal with.

Why do hormones change in your 40s?

Hormonal balance is largely a result of regular, healthy ovulation. The follicular phase, the time between the start of menstruation and ovulation is a time of abundant oestrogen, and then in the luteal phase, oestrogen declines (with a few spikes) while progesterone levels come to the show. It is all dependant on ovulation.

For this to all work in harmony, many factors need to be working seamlessly, such as stress hormones, inflammation, mitochondrial health and nutritional health. The previous cycle will affect subsequent cycles, as low progesterone often triggers higher levels of FSH.

As oocyte (egg) numbers decline and mitochondrial health depletes, the signals of the HPO axis in perimenopause are altered and ovulation doesn’t occur every cycle. This results in a gradual decline in progesterone, and fluctuating levels of oestrogen as the brain tries to adjust to the fluctuation of irregular ovulation.

Photo by Jonathan Borba on Unsplash

What is the difference between menopause and perimenopause?

Perimenopause is the time leading up to the definitive marker of menopause, the time when there has been 12 months since the last menstrual bleed. You are perimenopause in the time leading up to this moment, and post menopausal afterwards. Menopause is the umbrella term that incorporates all of these. It is worth noting that it is still possible to experience a random bleed in the post menopausal period, and if this occurs you should discuss with your health care practitioner as while it can be a renegade menstruation, it can also be a sign of something more concerning.

Should I take supplements to support my hormones?

Not everyone needs to take supplements, and many nutrients can be obtained through your diet. But there are a lot of people who aren’t eating enough of the vitamins and minerals that are essential for healthy hormones and nervous system health, or have genetic polymorphisms which increase their demand for certain nutrients.

These are some of my favourite supplements to support the perimenopausal period:

• Magnesium glycinate – this is important for nervous system health, blood sugar level regularity and is important for hormone creation and detoxification.
• Taurine – I often prescribe this alongside magnesium, as it can help with improving mood and energy (it interacts with GABA receptors, producing a calming effect). It is also important for bile acid formation and mitochondrial health.
• Ubiquinol – The activated form of Coq10 is more effectively used in those who are over 30 years of age. CoQ10 and its activated form ubiquinol are important for mitochondria health, which has many wide-reaching benefits including cardiovascular health, energy, immune function, skin health and other anti-aging properties and more.
• Collagen – As oestrogen lowers, the body’s ability to make and repair collagen reduces, so supplementation can help to offset some of this loss. Collagen can be helpful for improving skin, bone and joint health, and often is useful for digestive health concerns.
• Phyto-oestrogens – In particular, soy which is abundant in isoflavones have a regulating effect on hormones. Isoflavones have been studied abundantly and found to be helpful for managing menopausal symptoms, as well as being protective against several of the long-term risks of menopause such as osteoporosis and cardiovascular disease. It is protective against many forms of hormone-dependant cancers. I advise avoiding the overly refined forms of soy products, and opting for those made with the whole bean such as traditional soy foods, or milks made from the whole bean rather than the isolate.

There are many more nutritional supplements that can be beneficial, as well as herbal medicines that can support you through this period. I discuss these in more detail in my ecourse Natural Menopause Support. Alternatively, get in touch with your health care practitioner to help work out what your individual requirements are, as well as what doses you may need.

How do I know if I’m going through perimenopause?

This is a very common question, and unfortunately it doesn’t have a simple answer. Hormone testing can provide some insight into whether you are getting closer to perimenopause, but it can be difficult to interpret because of the fluctuations that occur in perimenopause.

The best way to know if you are going through perimenopause is taking several factors into consideration such as your age, your maternal family’s menopausal experience, your symptoms – notably your cycle regularity and whether this has changed.

Blood tests may show a gradual increase in FSH (follicle stimulating hormone) and a decline in progesterone. Oestrogen levels can fluctuate in perimenopause, so they may be high or low. After menopause when you have not ovulated for at least 12 months, oestrogen and progesterone will be considerably lower, and FSH will usually be much higher.

How to lose weight in your 40s

It may seem like losing weight as you get older becomes more of a struggle, and that’s because your hormonal shifts cause your metabolic health to change. Insulin resistance is a by product of reduced oestrogen, which makes losing weight, especially around the abdomen more difficult than it was when you were younger. If there are other hormonal imbalances at play such as PCOS, oestrogen excess, thyroid dysfunction or chronic stress/HPA dysfunction this can also contribute towards difficulty losing weight with standard methods.

Assessing your hormonal situation is the first step to identify barriers to weight loss, and then you can make diet and exercises choices that will work best for you.

In the majority of cases the staples of weight loss still need to come into play, such as ensuring you are eating the correct amount of calories, exercising and maintaining muscle mass, and getting adequate sleep.

GLP-1 and GIP medications are becoming more popular, and while they can be very helpful in the weight loss journey they do have side effects and risks that need to be managed. As with any other weight loss approach, they are not a long term solution but can be helpful whilst other factors such as diet and lifestyle habits are improved, and hormonal imbalance is supported.

When should I consider HRT?

This is an individual decision and needs to be done in collaboration with your health care practitioner. Menopausal Hormonal Therapy (MHT), previously known as Hormonal Replacement Therapy (HRT) has had many advances in safety and can be used to help navigate the symptoms with low oestrogen, progesterone and/or DHEA. In perimenopause, progesterone therapy is more commonly used cyclically, with oestrogen being more beneficial only in the times when low oestrogen occurs. As oestrogen fluctuates in perimenopause, it is often not used until after ovulation has ceased.

Some people experience negative effects from taking MHT, but this doesn’t mean that MHT is not for you, but rather that you need to have your individual needs taken into consideration. If you feel worse from MHT, this may be due to poor detoxification of oestrogens or because your hormones are still fluctuating too wildly, as taking additional oestrogen when it is already high can cause issues such as heavy bleeding, headaches or mood changes.

You may be able to find out if you are not detoxing your hormones properly with a test that assesses the ratio of your hormone metabolites, such as the DUTCH test or EndoMap.

Should I see a naturopath for perimenopause?

Perimenopause and menopause are one of the most common reasons that people seek help from a naturopath, and for good reason. There is so much that can be done to support people going through this transition naturally, including supporting symptoms and hormonal fluctuations with herbal medicine, nutritional supplements to reduce symptoms and improve wellbeing, and education and guidance around diet and lifestyle adjustments that can help to both reduce the symptoms of this time and reduce the risks associated with after menopause such as osteoporosis, genito-urinary changes and cardiovascular and metabolic health.

Because this is such a common thing that people seek help with, I have created an ecourse – Natural Menopause Support – which provides an abundance of education about what is going on in menopause and perimenopause, as well as guidance on navigating the remedies that may be helpful.

As you move through your 40s, understanding and supporting your hormones can make a world of difference to how you feel each day. Perimenopause doesn’t have to be a confusing or uncomfortable time — with the right nutrition, lifestyle support, and individualised care, you can navigate this stage feeling strong, informed, and in tune with your body.

If you’d like to dive deeper into natural ways to manage symptoms and restore hormonal balance, you’ll find plenty of guidance in my Natural Menopause Support eCourse, where I share practical tools and naturopathic insights to help you thrive through perimenopause and beyond.

The post How to Support Your Hormones Naturally in Your 40s appeared first on Alison Mitchell Naturopath.

Understanding and treating missing periods naturally.

Hypothalamic Amenorrhoea (HA) is a condition you may have been hearing about more frequently lately. Despite being a bit of a mouthful to pronounce, this condition is unfortunately more common than many women realise. In simple terms, HA occurs when your brain stops communicating properly with your reproductive system, causing your periods to go completely AWOL! Let’s explore this condition in depth to help you understand what’s happening in your body.

Understanding Primary vs Secondary Amenorrhoea

Before diving deeper, it’s important to understand the difference between primary and secondary amenorrhoea:

Primary amenorrhoea refers to when a young woman hasn’t started menstruating by age 16, despite having undergone other normal pubertal development.

Secondary amenorrhoea, which includes Hypothalamic Amenorrhoea, occurs when menstrual periods that were previously normal and regular stop for three or more consecutive months in a woman who was previously menstruating.

Photo by Rodolfo Sanches Carvalho on Unsplash

What is Hypothalamic Amenorrhoea?

Hypothalamic Amenorrhoea exclusively affects women, as it’s directly related to the female reproductive system. This condition is characterised by the absence of menstrual cycles for three months or longer, and in some serious cases, periods can disappear for years.

HA stems from disruptions in your hypothalamus function – a small but mighty structure located in your brain. The hypothalamus serves as the control centre for numerous vital bodily functions, including:

• Regulating body temperature
• Managing hunger and thirst signals
• Controlling blood pressure
• Governing your sleep-wake cycle
• Influencing sex drive
• Orchestrating hormone production and activity

When the hypothalamus senses that your body is under stress, it responds by reducing the production of gonadotropin-releasing hormone (GnRH), which subsequently affects the release of follicle-stimulating hormone (FSH) and luteinising hormone (LH) – both crucial for ovulation and menstruation.

What Causes Hypothalamic Amenorrhoea?

Several factors can trigger this protective response from your body:

• Nutritional deficiencies or inadequate caloric intake: Your body needs sufficient energy to maintain reproductive function
• Excessive exercise or overtraining: This can occur across many activities and sports, not limited to any particular field. Even regular fitness enthusiasts can experience HA if their exercise regimen is too intense relative to their individual needs and caloric intake
• Chronic or elevated stress levels: Both psychological and physical stress can disrupt hormonal balance
• Low body weight or rapid weight loss: Even if you’re not clinically underweight
• History of oral contraceptive use: Some women experience delayed return of menstruation after stopping the pill
• A combination of these factors: Often multiple stressors compound the effect

It’s important to note that susceptibility to HA varies significantly between individuals. Some women can maintain intensive exercise routines or experience temporary stress without losing their periods, while others are more sensitive to these factors. This is why comparing your diet and exercise regime to others isn’t a good idea – your body has its own unique thresholds and requirements.

Many women experiencing HA don’t fit any stereotype. Even moderate caloric restriction combined with regular exercise and everyday stress can be enough to trigger this condition in susceptible individuals.

Why Does My Body Stop Menstruating?

From an evolutionary perspective, your body has sophisticated mechanisms to protect you during times of perceived threat. When your brain detects signals of potential famine (insufficient calories), physical danger (excessive exercise), or emotional threat (chronic stress), it essentially puts reproduction on the backburner to conserve energy for survival.

Think of it as your body’s wisdom – if resources are scarce or conditions aren’t optimal, it’s not an ideal time to support a pregnancy. Your body prioritises vital functions over reproductive capabilities until conditions improve.

The intricate hormone cascade that regulates your menstrual cycle requires everything to be working in harmony. When disrupted, the delicate balance of oestrogen, progesterone, LH, and FSH becomes compromised, resulting in anovulation (lack of ovulation) and subsequently, no menstruation.

It’s important to note that while HA is a common cause of secondary amenorrhoea (periods stopping after they’ve been established), other conditions such as PCOS, thyroid disorders, and premature ovarian insufficiency can present similarly. This is why proper diagnosis through a healthcare provider is essential.

Signs and Symptoms of Hypothalamic Amenorrhoea

Beyond the obvious absence of menstruation, you might experience:

• Low energy levels and fatigue
• Mood changes, including anxiety or depression
• Disrupted sleep patterns
• Reduced sex drive
• Dry skin and brittle hair
• Cold intolerance (feeling cold frequently)
• Bone density concerns (if prolonged)
• Difficulty concentrating
• Digestive changes

Comprehensive Approach to Managing Hypothalamic Amenorrhoea

Restoring your menstrual cycle requires a holistic approach targeting the root causes. As a naturopath, I find that a balanced strategy incorporating lifestyle modifications, nutrition, targeted herbs, and supplements offers the most effective path to recovery.

Nourishing Nutrition for Hormone Health

• Increase caloric intake: Most women with HA need at least 2,000-2,500 calories daily, sometimes more depending on activity level and body composition
• Prioritise carbohydrates: Adequate carbohydrate intake is absolutely crucial for hypothalamic function and hormone production. Your brain relies heavily on glucose, and including plenty of complex carbohydrates is essential. Include foods like sweet potatoes, pumpkin, whole grains (freekeh, quinoa, buckwheat, rice), sourdough bread, legumes, and starchy vegetables to provide essential energy for hormone production
• Include quality protein: Aim for 1.2-1.8g per kg of body weight from varied sources like eggs, fish, legumes, and quality animal products
• Prioritise healthy fats: Your reproductive hormones are made from cholesterol and require adequate fat intake. Include avocados, olive oil, nuts, seeds, and fatty fish in your diet
• Don’t fear dietary fat: 30-40% of your calories should come from healthy fats to support hormone synthesis
• Support gut health: Consume fermented foods (yoghurt, kefir, sauerkraut) and prebiotic fibres to maintain the gut-hormone connection (Note: fermented foods may not be suitable for those with histamine intolerance)
• Important: Under no circumstances should you attempt a low or no-carb diet when dealing with HA – your body needs carbohydrates to signal reproductive safety

Supportive Lifestyle Practices

• Effective stress management: Practice daily meditation, journalling, or gentle breathwork
• Prioritise sleep quality: Aim for 7-9 hours of uninterrupted sleep in a cool, dark room
• Connect with nature: Forest bathing (shinrin-yoku) has been shown to reduce cortisol levels
• Sunlight exposure: 15-30 minutes of morning sunlight helps regulate circadian rhythms and vitamin D production, both crucial for hormone health
• Mindful breathing: Practice 4-7-8 breathing (inhale for 4, hold for 7, exhale for 8) several times daily to activate your parasympathetic nervous system
• Create boundaries: Learn to say no to excessive commitments that contribute to your stress load

Appropriate Exercise Modifications

During recovery from HA, it’s crucial to scale back high-intensity exercise until regular menstruation returns. Consider these gentler alternatives:

• Restorative yoga: Focus on yin or gentle hatha practices that activate the relaxation response
• Pilates: Build core strength without excessive cardio stress
• Mindful walking: Particularly in natural settings at a conversational pace
• Gentle swimming: Non-weight bearing and relaxing for the nervous system
• Mobility work: Maintain flexibility without taxing your adrenal system

Once your cycles have returned consistently for 3-6 months, you can gradually reintroduce more intensive exercise while carefully monitoring your menstrual health.

Herbs & Supplements for Hormonal Support

Herbal Allies:

• Adaptogenic herbs: Help balance the body’s stress response and support adrenal function
  • Withania (Ashwagandha): Helps reduce cortisol and supports thyroid function
  • Rhodiola rosea: Enhances stress resilience and energy without stimulation
  • Holy Basil (Tulsi): Balances stress hormones and supports metabolic health
• Nervous system supporters:
  • Chamomile: Gentle calming effect without sedation
  • Passionflower: Reduces anxiety and promotes restful sleep
  • Lemon balm: Uplifts mood while calming the nervous system

Targeted Supplements:

• Acetyl-L-carnitine: Supports LH production and egg quality
• Magnesium glycinate: Essential for over 300 enzymatic reactions, including hormonal pathways (300-450mg daily)
• Zinc: Critical for reproductive hormone function and thyroid health (15-30mg daily)
• Vitamin D3: Many women with HA have insufficient levels (2000-5000 IU daily, based on blood levels)
• B-complex vitamins: Support energy production and stress response
• Omega-3 fatty acids: Provide building blocks for hormone production (1-3g daily)

When to Seek Professional Support

Recovery from Hypothalamic Amenorrhoea typically takes 3-12 months, depending on the severity and duration of the condition. While some women see improvements within weeks of implementing these changes, others require more time and personalised support.

If you’re experiencing:

• Absence of periods for more than 3 months
• Symptoms that significantly impact your quality of life
• Concerns about fertility or bone health
• Difficulty implementing lifestyle changes alone

It’s time to seek professional guidance. As a naturopath specialising in women’s hormonal health, I can help identify the specific factors contributing to your HA and create a personalised recovery plan that addresses your unique needs.

Your Path to Hormonal Balance Starts Here

Hypothalamic Amenorrhoea is not just about getting your period back—it’s about restoring your body’s natural rhythms and creating sustainable health practices that support your hormonal wellbeing for life.

If your periods have disappeared or become irregular and you suspect Hypothalamic Amenorrhoea might be the cause, I invite you to book a consultation today. Together, we’ll investigate the root causes of your hormonal imbalance and develop a comprehensive plan to restore your menstrual health naturally.

Your body wants to heal—sometimes it just needs the right support to find its way back to balance.

References

Abou Sherif, S., Newman, R., Haboosh, S., Al-Sharefi, A., Papanikolaou, N., Dimakopoulou, A., Webber, L. J., Abbara, A., Franks, S., Dhillo, W. S., & Jayasena, C. N. (2021). Investigating the potential of clinical and biochemical markers to differentiate between functional hypothalamic amenorrhoea and polycystic ovarian syndrome: A retrospective observational study. Clinical endocrinology, 95(4), 618–627. https://doi.org/10.1111/cen.14571

Gordon, C. M., Ackerman, K. E., Berga, S. L., Kaplan, J. R., Mastorakos, G., Misra, M., Murad, M. H., Santoro, N. F., & Warren, M. P. (2017). Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline. The Journal of clinical endocrinology and metabolism, 102(5), 1413–1439. https://doi.org/10.1210/jc.2017-00131

Meczekalski, B., Katulski, K., Czyzyk, A., Podfigurna-Stopa, A., & Maciejewska-Jeske, M. (2014). Functional hypothalamic amenorrhea and its influence on women’s health. Journal of endocrinological investigation, 37(11), 1049–1056. https://doi.org/10.1007/s40618-014-0169-3

Mountjoy, M., Sundgot-Borgen, J., Burke, L., Carter, S., Constantini, N., Lebrun, C., Meyer, N., Sherman, R., Steffen, K., Budgett, R., & Ljungqvist, A. (2014). The IOC consensus statement: beyond the Female Athlete Triad–Relative Energy Deficiency in Sport (RED-S). British journal of sports medicine, 48(7), 491–497. https://doi.org/10.1136/bjsports-2014-093502

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