When it comes to fertility, hormone balance and energy, we often focus on things like nutrition, stress, sleep or hormone levels. While these are all important, there is another piece of the puzzle that deserves more attention: mitochondria.

Mitochondria are often referred to as the powerhouses of the cell because they produce ATP, the energy currency that powers almost every process in the body. However, their role extends far beyond energy production. Mitochondria are involved in hormone production, DNA repair, immune function, inflammation regulation, cell signalling and healthy ageing.

Because mitochondria are involved in so many essential functions, dysfunction has been linked to a wide range of health concerns including fertility challenges, recurrent miscarriage, endometriosis, chronic fatigue, depression, autism spectrum disorder and age-related hormonal decline.

From a naturopathic perspective, supporting mitochondrial health is often an important part of improving overall wellbeing. Healthy mitochondria help create the foundation for healthy cells, healthy hormones and healthy ageing.

Mitochondria and Fertility

Fertility is one of the areas where mitochondrial health is particularly important.

Mitochondria help regulate energy production within both egg and sperm cells, but they are also involved in DNA repair, hormone production and healthy embryonic development.

One of the hormones produced with the help of mitochondrial function is pregnenolone. Pregnenolone is often referred to as the “mother hormone” because it serves as the precursor for progesterone, oestrogen, testosterone and cortisol. When mitochondrial function is compromised, hormone production can also be affected.

Mitochondria are also involved in glucose metabolism and blood sugar regulation. This is particularly relevant because unstable blood sugar levels can influence fertility, ovulation, hormone production and overall reproductive health.

Perhaps one of the most fascinating aspects of mitochondrial biology is that babies inherit their mitochondria exclusively from their mother. This means mitochondrial health doesn’t just affect fertility today. It may also influence the health and fertility of future generations.

For this reason, mitochondrial support can be an important consideration in preconception care and natural fertility support.

Why Egg Cells Need So Many Mitochondria

Egg cells (oocytes) are remarkable. They contain anywhere from 100,000 to more than one million mitochondria, far more than almost any other cell in the body. This enormous energy reserve is needed to support egg maturation, fertilisation and the earliest stages of embryonic development.

As women age, mitochondrial function within the ovaries gradually declines. By the age of 40, it is estimated that almost one-third of the mitochondria within oocytes are no longer functioning efficiently. This decline is one of the reasons fertility naturally decreases with age.

When fertilisation occurs, the egg does more than simply receive genetic material from the sperm. If there is DNA damage within the sperm, the oocyte uses its own mitochondrial reserves to help repair that damage. This process is essential for creating a healthy embryo.

Because of these demands, egg quality is closely tied to mitochondrial health.

Why Sperm Health Matters

While sperm are tiny compared to an egg, they contribute half of the genetic material needed to create a baby. Male fertility is often prioritized less then female fertility, yet male factor issues contribute to around 50% of fertility challenges.

Unlike egg cells, sperm contain only a few dozen mitochondria. These mitochondria are located within the midpiece of the sperm and provide the energy required for movement.

At the moment of conception, the sperm penetrates the egg and delivers its DNA into the oocyte. The sperm mitochondria themselves are not inherited by the baby. Instead, the egg uses its own mitochondrial resources to support early development and repair any damage present within the sperm DNA.

Sperm are particularly vulnerable to oxidative stress and damage from reactive oxygen species (ROS). Excessive oxidative stress can impair mitochondrial function, reduce motility and increase DNA fragmentation.

Sperm health also influences much more than fertilisation. Research suggests that sperm quality affects placental development and may contribute to miscarriage risk. This is why supporting sperm health is just as important as supporting egg quality when preparing for pregnancy.

Mitochondria, Perimenopause and Menopause

Mitochondrial health isn’t only associated with fertility – these tiny structures may also influence when a woman transitions into perimenopause and menopause.

As women age, the number and function of mitochondria within the ovaries gradually decline. Research suggests that by age 40, approximately one-third of mitochondria within oocytes are no longer functioning efficiently.

Human oocytes contain between 100,000 and more than one million mitochondria because egg maturation and early embryonic development require vast amounts of energy. The rate at which these mitochondria decline appears to influence reproductive ageing.

Research published in 2024 demonstrated that reducing mitochondrial DNA accelerated reproductive ageing in animal models. This suggests that mitochondrial function may play an important role in determining the pace of ovarian ageing and potentially the timing of perimenopause and menopause.

This may help explain why many women notice changes in energy, recovery, metabolic health and stress resilience during the perimenopausal transition, however there is much more involved (if you’d like to learn more about perimenopause and menopause, go on the wait list for my upcoming book Natural Menopause Support).

Researchers have also identified CoQ10 as an important nutrient within ovarian tissue. One landmark study found that age-related declines in egg quality were partly driven by reduced CoQ10 availability within the oocyte. Supplementation helped preserve ovarian reserve, improve egg quality and restore fertility in aged mice. Additional research has also demonstrated improvements in progesterone production.

While ageing is a natural process, supporting mitochondrial health may help support healthier ovarian ageing and improve resilience during the transition into perimenopause and menopause.

Mitochondria and Endometriosis

While we’re on the topic of women’s health, it’s worth exploring the connection between mitochondria and endometriosis.

Many people think of endometriosis primarily as a hormonal condition, but there is also a significant immune and inflammatory component.

Women with endometriosis often experience increased oxidative stress, elevated inflammatory markers and altered immune function. Mitochondria are involved in all three of these processes.

When mitochondria become dysfunctional, they can produce excessive amounts of reactive oxygen species. This creates a cycle of oxidative stress and inflammation that may contribute to the growth and persistence of endometriosis lesions.

Mitochondria also play an important role in immune cell function and inflammatory signalling. When mitochondrial function is impaired, immune regulation can become disrupted, potentially contributing to the chronic inflammatory environment seen in endometriosis.

This is one reason why a holistic approach to endometriosis management often extends beyond hormones alone. Supporting mitochondrial health alongside nervous system regulation, immune function, gut health and hormonal balance may help address some of the underlying drivers involved in the condition.

Mitochondria, Mood and Brain Health

The brain is one of the most energy-demanding organs in the body.

Every thought, memory, movement and emotion requires energy. Healthy mitochondrial function helps support neurotransmitter production, nerve cell communication and overall brain function.

When mitochondrial function is impaired, symptoms such as brain fog, poor concentration, low mood and fatigue may occur.

Emerging research has also found that mitochondrial dysfunction is common in individuals with Autism Spectrum Disorder (ASD). Studies have identified abnormalities in mitochondrial energy production, increased oxidative stress and higher levels of neuroinflammation in some individuals with ASD.

Because mitochondria play such a central role in brain energy metabolism, supporting mitochondrial health may be an important consideration in conditions involving cognitive function, mood and neurological health.

Signs Your Mitochondria May Need Support

Some common signs that mitochondrial function may be struggling include:

• Persistent fatigue
• Poor exercise recovery
• Muscle weakness
• Brain fog
• Poor concentration
• Low mood
• Fertility challenges
• Hormonal imbalances
• Reduced resilience to stress
• Feeling older than your age

These symptoms can have many different causes, but mitochondrial dysfunction is one possible contributor worth considering.

Supporting Mitochondrial Health Naturally

Mitochondrial support is rarely about a single supplement. Instead, it involves creating an environment that allows these cellular powerhouses to function optimally.

Some of the ways mitochondrial health can be supported include:

• Prioritising quality sleep, as much of the body’s cellular repair occurs during sleep
• Maintaining stable blood sugar levels through a balanced diet
• Regular exercise, which stimulates the production of new mitochondria
• Spending time outdoors and supporting healthy circadian rhythms
• Cold exposure, which may help improve mitochondrial resilience and adaptation
• Supporting gut health and addressing dysbiosis where present
• Reducing exposure to environmental toxins where possible
• Ensuring adequate intake of nutrients required for mitochondrial function
• Supporting nervous system regulation and reducing chronic stress

Because mitochondrial health sits at the intersection of fertility, hormones, inflammation, energy production and healthy ageing, it can be a valuable area of focus in naturopathic care.

If you’re struggling with fertility challenges, subfertility, recurrent miscarriage, endometriosis, fatigue, hormone imbalances or perimenopausal symptoms, supporting mitochondrial health may be one piece of the puzzle worth exploring.

References

1. Annesley, S. J., & Fisher, P. R. (2019). Mitochondria in Health and Disease. Cells, 8(7), 680. https://doi.org/10.3390/cells8070680
2. Ben-Meir, A., Burstein, E., Borrego-Alvarez, A., Chong, J., Wong, E., Yavorska, T., Naranian, T., Chi, M., Wang, Y., Bentov, Y., Alexis, J., Meriano, J., Sung, H. K., Gasser, D. L., Moley, K. H., Hekimi, S., Casper, R. F., & Jurisicova, A. (2015). Coenzyme Q10 restores oocyte mitochondrial function and fertility during reproductive aging. Aging cell, 14(5), 887–895. https://doi.org/10.1111/acel.12368
3. Ben-Meir, A., Kim, K., McQuaid, R., Esfandiari, N., Bentov, Y., Casper, R. F., & Jurisicova, A. (2019). Co-Enzyme Q10 Supplementation Rescues Cumulus Cells Dysfunction in a Maternal Aging Model. Antioxidants (Basel, Switzerland), 8(3), 58. https://doi.org/10.3390/antiox8030058
4. Chiang, J. L., Shukla, P., Pagidas, K., Ahmed, N. S., Karri, S., Gunn, D. D., Hurd, W. W., & Singh, K. K. (2020). Mitochondria in Ovarian Aging and Reproductive Longevity. Ageing research reviews, 63, 101168. https://doi.org/10.1016/j.arr.2020.101168
5. Khaliulin, I., Hamoudi, W., & Amal, H. (2025). The multifaceted role of mitochondria in autism spectrum disorder. Molecular psychiatry, 30(2), 629–650. https://doi.org/10.1038/s41380-024-02725-z
6. Kobayashi, H., & Imanaka, S. (2024). Mitochondrial DNA Damage and Its Repair Mechanisms in Aging Oocytes. International journal of molecular sciences, 25(23), 13144. https://doi.org/10.3390/ijms252313144
7. Kramer, P., & Bressan, P. (2018). Our (Mother’s) Mitochondria and Our Mind. Perspectives on psychological science : a journal of the Association for Psychological Science, 13(1), 88–100. https://doi.org/10.1177/1745691617718356
8. Long, S., Zheng, Y., Deng, X., Guo, J., Xu, Z., Scharffetter-Kochanek, K., Dou, Y., & Jiang, M. (2024). Maintaining mitochondrial DNA copy number mitigates ROS-induced oocyte decline and female reproductive aging. Communications biology, 7(1), 1229. https://doi.org/10.1038/s42003-024-06888-x
9. Melhuish Beaupre, L. M., Brown, G. M., Braganza, N. A., Kennedy, J. L., & Gonçalves, V. F. (2022). Mitochondria’s role in sleep: Novel insights from sleep deprivation and restriction studies. The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry, 23(1), 1–13. https://doi.org/10.1080/15622975.2021.1907723
10. Tesarik, J., & Mendoza-Tesarik, R. (2023). Mitochondria in Human Fertility and Infertility. International journal of molecular sciences, 24(10), 8950. https://doi.org/10.3390/ijms24108950
11. May-Panloup, P., Boucret, L., Chao de la Barca, J. M., Desquiret-Dumas, V., Ferré-L’Hotellier, V., Morinière, C., Descamps, P., Procaccio, V., & Reynier, P. (2016). Ovarian ageing: the role of mitochondria in oocytes and follicles. Human reproduction update, 22(6), 725–743. https://doi.org/10.1093/humupd/dmw028
12. Vaught, R. C., & Dowling, D. K. (2018). Maternal inheritance of mitochondria: implications for male fertility?. Reproduction (Cambridge, England), 155(4), R159–R168. https://doi.org/10.1530/REP-17-0600
13. Wen, Y., & Yao, Y. (2021). Autism Spectrum Disorders: The Mitochondria Connection. In A. M. Grabrucker (Ed.), Autism Spectrum Disorders. Exon Publications. https://doi.org/10.36255/exonpublications.autismspectrumdisorders.2021.mitochondria

The post Mitochondria and Fertility: Egg Quality, Endometriosis, Menopause and Healthy Ageing appeared first on Alison Mitchell Naturopath.

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.

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