Perimenopause is a powerful transition, but for many women, it doesn’t feel that way. You might experience irregular cycles, disrupted sleep, anxiety, fatigue, low mood, or feel like your body and mind are changing faster than you can keep up.
Hormone Replacement Therapy (HRT) is often presented as the go-to solution. For some, it’s essential and can provide relief when symptoms are severe. But for many others, it’s not the right fit—or not the first step they want to take.
There is another way.
By supporting your body’s natural hormone regulation through diet, lifestyle, and targeted nutrients, you can reduce symptoms, feel more balanced, and take back control of your health—whether or not you choose HRT.
What’s Actually Happening in Perimenopause?
Hormone levels—especially oestrogen and progesterone—rise and fall unevenly in the years before menopause. These fluctuations affect every system in the body, including the brain, gut, immune system, and nervous system.
You’re not imagining things. The symptoms are real. Some of the most common include:
- Irregular or heavy periods
- Severe PMS or PMDD with mood swings, irritability, anxiety or depression
- Hot flushes and night sweats
- Fatigue, low motivation, and disrupted sleep
- Brain fog, memory lapses, and difficulty concentrating
- Low libido and vaginal dryness
- Weight gain, especially around the middle
- Increased stress sensitivity and feelings of overwhelm
This isn’t just about oestrogen “running out.” It’s about how well your body adapts—and that’s something you can influence.
What Are the Risks of HRT?
For some women, HRT plays a necessary role—especially in cases of early menopause, surgical menopause, or severe vasomotor symptoms.
But it’s important to understand that HRT is not risk-free.
Here’s what the research shows:
- Breast cancer: Combined HRT (oestrogen and progestogen) is associated with a small increased risk of breast cancer, especially after 4–5 years of use. Oestrogen-only HRT appears to carry a lower risk in women who’ve had a hysterectomy (Collaborative Group, 2019).
- Blood clots: Oral oestrogen increases the risk of venous thromboembolism (VTE). Transdermal options (patches, gels) appear safer in this respect.
- Stroke and heart disease: Starting HRT later in life (after age 60 or more than 10 years after menopause) may increase cardiovascular risk.
- Irregular bleeding and fibroid growth: HRT can sometimes worsen bleeding patterns or stimulate fibroid growth, particularly in the early stages.
- Mood instability: In some women, HRT may worsen anxiety or mood swings if not well matched to their needs.
HRT can be helpful. But it’s not a cure-all. And it doesn’t address the deeper metabolic and inflammatory changes that come with this life phase.
Natural Support: The Foundation of Hormone Balance
The good news is that your body has its own built-in hormonal intelligence—and there is a great deal you can do to support it.
Functional nutritional therapy works by addressing the systems that regulate, metabolise, and clear hormones. It also supports energy, cognition, mood, and resilience.
Blood Sugar Balance
When blood sugar spikes and crashes, cortisol increases, progesterone drops, and oestrogen metabolism is disrupted. A focus on balanced meals—with plenty of protein, fibre, healthy fats, and slow carbs—can help regulate hormones and reduce symptoms like fatigue, mood swings, and cravings.
Liver and Gut Health
Your liver breaks down oestrogen and progesterone, while your gut eliminates them. If either system is under-functioning, hormonal symptoms can worsen. Supporting both with cruciferous vegetables, fibre, bitter greens, and fermented foods can make a major difference.
Nutrient Replenishment
Key nutrients—magnesium, B vitamins, vitamin D, zinc, and omega-3 fatty acids—are vital for hormone production, neurotransmitter function, and nervous system balance. Deficiencies in these areas are common in perimenopause and can increase symptoms like anxiety, insomnia, low libido, and brain fog.
Inflammation Reduction
Many symptoms of perimenopause are driven by chronic low-grade inflammation. An anti-inflammatory diet rich in colourful vegetables, herbs and spices, oily fish, and olive oil helps reduce joint pain, bloating, fatigue, and poor concentration.
This approach not only supports your hormones now—it protects your long-term health, including your bones, heart, and brain.
If You Do Choose HRT, Nutritional Therapy Still Matters
Even if HRT is part of your plan, your body still needs to metabolise and eliminate those hormones. If liver and gut function are sluggish, HRT can increase symptoms like bloating, breast tenderness, and mood instability.
Nutritional therapy helps to:
- Reduce unwanted side effects of HRT
- Improve detoxification and hormone clearance
- Support nutrient status for bone, brain, and cardiovascular health
- Enhance the effectiveness of your treatment overall
You don’t have to choose between HRT and natural support. But nutrition should never be left out of the picture.
Case Study 1: Natural Support Without HRT
Client: 45-year-old primary school teacher with heavy periods, low mood, and brain fog
Approach: She wanted to avoid HRT and support her body naturally. We focused on stabilising blood sugar, increasing magnesium and B6 through food and supplements, and improving gut function.
Outcome: Within 6 weeks her energy improved and brain fog lifted. Periods became more manageable. By 3 months, her mood stabilised and she was sleeping more deeply without night sweats.
Case Study 2: HRT with Nutritional Therapy Support
Client: 53-year-old in full-time work using transdermal oestradiol and micronised progesterone
Symptoms: Despite HRT, she struggled with persistent fatigue, bloating, and low libido.
Approach: We addressed liver function, reduced inflammatory foods, and introduced a more protein-rich diet alongside targeted nutrients like omega-3s and zinc.
Outcome: Her digestion improved, bloating reduced, and energy levels returned. Libido improved within 2 months. She described the changes as “finally getting the full benefit from HRT.”
You Deserve More Than Symptom Management
Perimenopause is a unique opportunity to reconnect with your body’s needs and build a more resilient foundation for long-term health.
You don’t need to wait until things get worse. And you don’t need to do this alone.
Whether you’re considering HRT, already using it, or prefer a fully natural approach—I’m here to help you understand your options and feel like yourself again.
Book a free discovery call today, and let’s work together to support your hormones with a personalised, functional approach that works for your life.
References
- Mukherjee, A. Davis, S.R.(2025). Update on Menopause Hormone Therapy; Current Indications and Unanswered Questions. Clinical Endocrinology, https://doi.org/10.1111/cen.15211
- International Menopause Society, 2024. Menopause and MHT in 2024: addressing the key controversies. Climacteric, 27(5), pp.441–457.
- Collaborative Group on Hormonal Factors in Breast Cancer. (2019). Type and timing of menopausal hormone therapy and breast cancer risk. The Lancet, 394(10204), 1159–1168.
- NICE (2016). Menopause: diagnosis and management. NICE Guideline NG23.
- British Menopause Society (2023). Tools for clinicians. Available at: www.thebms.org.uk