How to Naturally Manage Perimenopause

You might notice changes in your sleep or mood long before you realise you're approaching menopause. For some women, it's the hot flushes. Others find themselves struggling with fatigue, irregular periods, irritability or mood swings that seem to come out of nowhere. These are all possible perimenopause or early menopause symptoms, as your ovaries start producing oestrogen and progesterone less predictably. There are ways to support your body through these hormonal changes, including adjustments to your diet, exercise habits and daily routine.

Natural treatments can also be used alongside hormone replacement therapy. A 2026 review of integrative approaches to perimenopause highlights the value of combining natural and conventional approaches to care. As perimenopause can last around 4-8 years on average, sometimes up to 10 years, finding the right support for you can make a real difference along the way.

If you're looking for help managing your symptoms, Floralia's naturopaths offer personalised perimenopause and menopause support based on your health history and individual needs.

What to eat to support your body during perimenopause

What you eat can influence how you feel during perimenopause, particularly when it comes to energy levels and maintaining a healthy weight. For healthy eating during perimenopause, a Mediterranean-style diet is a good starting point, with plenty of vegetables, legumes such as lentils and chickpeas, whole grains, nuts and olive oil making up much of what you eat.

Soybeans, tofu and tempeh have something in common beyond being good sources of protein. They contain phytoestrogens, plant compounds that have a weak oestrogen-like action in the body. Ground flaxseed contains these compounds, too. Researchers have been looking at the possible effects of phytoestrogens on hot flushes, particularly as women approach menopause.

Soy foods have been studied for their effects on menopause symptoms, but the results can vary. One study, the WAVS dietary trial (Women's Study for the Alleviation of Vasomotor Symptoms), published in Menopause, the journal of The Menopause Society, looked at women eating a low-fat, plant-based diet that included half a cup of cooked soybeans each day. Women following this diet reported 88 per cent fewer moderate-to-severe hot flushes. Women in the control group reported a 34 per cent reduction. This suggests a plant-based diet with soy may help reduce hot flushes more than general changes alone.

As oestrogen levels decline during menopause, bone density can subsequently decrease, increasing the risk of osteoporosis and fractures. Bone loss often occurs without noticeable symptoms, which is why supporting bone health during this stage is particularly important. Adequate calcium (from dairy, leafy greens, tinned fish with soft bones or calcium-fortified soy milk) and vitamin D, alongside regular weight-bearing exercise, can help maintain bone strength and reduce the risk of fractures as you age.

Protein can be particularly supportive when energy levels and appetite feel unpredictable. Including a source of protein with meals, such as eggs, fish, legumes or tofu, can help support more stable blood sugar levels throughout the day. Fibre plays its own important role, nourishing beneficial gut bacteria (our microbiome) and supporting regular bowel movements. This is also relevant to hormone health, as the bowel helps eliminate oestrogen from the body after it has been processed by the liver.

Coffee and caffeine can affect women differently during perimenopause. You may find your usual coffee sits well with you, while someone else notices it triggers hot flushes or disrupts their sleep. Alcohol, spicy foods and hot drinks can also be triggers for some women. Rather than cutting things out unnecessarily, it can be helpful to notice how your body responds and make adjustments where needed.

If you suspect certain foods or drinks may be triggering your symptoms, try keeping a food and symptom diary for a couple of weeks. Note what you eat and drink, along with any hot flushes or changes you notice. Over time, you may begin to recognise patterns, or you might find there’s no clear connection at all. Either way, it can help you better understand your body and make choices that feel right for you.

Best exercise for perimenopause

Try to include two or three strength sessions each week, along with some regular aerobic exercise. Walking, swimming or cycling can all form part of your routine. Yoga is another option, especially if you're having trouble sleeping or if you're feeling more stressed than usual.

You don’t need heavy weights to build strength. Resistance bands, light dumbbells and bodyweight exercises are a great place to start. During perimenopause, declining oestrogen can contribute to bone loss, making strength training an important way to support bone health and maintain muscle. More muscle also helps your insulin sensitivity, which tends to fall around menopause.

Working your muscles against resistance two or three times a week can help slow these changes, particularly when it comes to maintaining strength and bone health.

Walking, cycling and dancing are all good ways to stay active during perimenopause. They support heart health, which matters more as your risk of cardiovascular disease rises after menopause, and you may notice improvements in your mood and sleep quality when you're exercising regularly.

A 2026 meta-analysis of 21 trials involving perimenopausal women found that exercise significantly reduced depressive symptoms. The researchers examined several forms of exercise, including walking, yoga, tai chi and resistance training. Yoga may be particularly helpful for women experiencing sleep disturbances or increased stress.

At Floralia Wellness, we see a lot of women coming in who are exercising regularly but still feeling fatigued and struggling with sleep. Sometimes, their food intake isn’t quite meeting their body’s needs. Under-fuelling while exercising can affect recovery, particularly during perimenopause, when sleep and energy levels may already be fluctuating.

A 2025 review of 25 perimenopause trials explored how exercise may support women during this stage of life. While the findings were encouraging, the studies varied in their approaches, meaning there’s no single exercise routine that suits everyone. The best approach is one that supports your individual needs, energy levels and overall wellbeing.

How to improve sleep and stress during perimenopause

You might wake during the night feeling uncomfortably hot, even when your bedroom is cool. You throw off the covers, only to pull them back on moments later. Night sweats can disrupt sleep like this several times a night, leaving you feeling exhausted the following day. Over time, this interrupted rest can take a toll on your energy and overall wellbeing.

Try getting up at around the same time each morning, including after a night when you haven't slept well. Spending some time outside early in the day can help your body clock adjust to a regular routine. If you drink coffee, think about when you're having your last cup. Caffeine can still be affecting your sleep hours later, so you could try cutting out afternoon coffee for a week or two.

Stress can affect your symptoms, too. You might have more hot flushes or mood swings during a difficult week at work. Chronic stress can disrupt normal cortisol regulation. However, the relationship between stress and changing hormone levels remains complicated.

Finding small ways to unwind can help you manage stress, whether that’s reading a book, spending time in the garden or taking an evening walk. You don’t need to set aside a specific amount of time; even a few quiet moments can make a difference. If you find it difficult to switch off at night, try a few minutes of slow, gentle breathing before bed.

Sleep habits that help night sweats and waking

If night sweats are disturbing your sleep, try keeping your bedroom cool and using lighter bedding. A fan or an open window may help, especially during warmer nights. It may also be helpful to sleep under several thin layers so you can easily take one off without having to get out of bed.

You might find that alcohol helps you unwind in the evening but leaves you waking during the night. It can disrupt sleep in the early hours of the morning and affect your body temperature, potentially making night sweats more noticeable.

If you suspect alcohol is contributing to restless nights, try having your last drink earlier in the evening or taking a short break from alcohol for a week or two, then see whether your sleep quality improves.

Cognitive behavioural therapy (CBT), a type of talking therapy that helps you recognise and change unhelpful thought patterns and behaviours, has been shown to help some women manage menopause-related insomnia and night sweats. Clinical hypnosis has also been studied as an approach to managing vasomotor symptoms (hot flushes and night sweats), with some research suggesting it may help reduce their frequency and improve sleep.

Calming stress and mood

CBT is another option for women who are finding the emotional symptoms of perimenopause difficult to manage. A 2025 review of 16 studies looked at its effects on hot flushes, mood, sleep and quality of life. The researchers found improvements across these areas, with the strongest results coming from group CBT. Self-help programmes were included in the research, too, and these also showed some benefit.

You can practise mindfulness meditation at home without attending a class. Across 19 trials, mindfulness-based programmes were found to improve menopausal symptoms, anxiety, stress and sleep quality. Some women prefer guided sessions, while others find it easier to spend a few minutes sitting quietly and paying attention to their breathing.

If you feel a hot flush coming on, try slowing your breathing for a minute or two. Some women find this helps them stay calm while the flush passes. Studies haven't found consistent evidence that paced breathing reduces the frequency of hot flushes.

Some women find comfort in sharing their experiences of perimenopause with friends. Talking openly about mood changes or sleep can help you feel less alone and learn how others have managed similar symptoms. If low mood or anxiety persists, your GP can help you explore the support available.

Natural remedies for common perimenopause symptoms

Here’s how these strategies can help with common perimenopausal symptoms, and when it’s worth speaking with your GP.

Do herbal supplements help perimenopause?

Some herbal remedies have been studied for perimenopause, but the evidence for their effectiveness varies, with limited research available for others. The quality of the product is important, especially if you're taking prescription medicines that could interact with its ingredients.

A 2026 systematic review for the International Menopause Society, led by Australian researchers, examined the evidence for different herbal treatments. Black cohosh and Chinese herbal medicine were among the options with stronger research support. The findings provide a starting point for looking at individual herbal remedies and dietary supplements, alongside advice from the Australasian Menopause Society and healthdirect.

Some evidence:

• Some black cohosh extracts may reduce hot flushes during perimenopause. A meta-analysis of 22 trials found improvements in hot flushes and physical symptoms, but little evidence of an effect on anxiety or depression. However, the Australasian Menopause Society has raised concerns about its safety.

• Soy isoflavones have been tested for hot flushes, sleep and mood. A 2025 review in perimenopausal women found a small overall benefit from supplements, with mood showing the clearest improvement. There was no significant improvement in sleep. If you've had breast cancer or another oestrogen-sensitive condition, speak to your doctor before using soy isoflavone supplements.

• Red clover has shown a small reduction in the frequency of hot flushes in some studies.

• Vitamin E may reduce hot flushes by one or two each day, although the overall effect is relatively small.

• Saffron extract was investigated in a Perth-led trial of 86 perimenopausal women. Women taking it reported improvements in mood, but not hot flushes.

• Magnesium supplements are sometimes taken to improve sleep, although there's limited research specifically involving women during menopause.

Little or no evidence:

• There’s little evidence that evening primrose oil, wild yam or progesterone creams improve hot flushes. Wild yam and progesterone creams also don’t provide reliable protection for the uterine lining.

• Ashwagandha is often sold as one of the adaptogenic herbs for stress, but there's insufficient evidence for it in perimenopause, plus concerns about gut and liver effects.

Chinese herbal medicine has a long history of use during menopause. If you're interested in trying it, speak to a qualified Chinese medicine practitioner first. These treatments shouldn't be self-prescribed.

St John's wort can interact with antidepressants and the contraceptive pill. Dong quai can also interact with warfarin, increasing the risk of bleeding. Tell your pharmacist or practitioner about any medicines you're taking before starting herbal supplements.

If you're taking medication and looking for ways to manage perimenopause symptoms, a naturopath consultation with Floralia can help you explore options that complement your existing care.

When to see your GP about perimenopause symptoms

See your GP if your periods become very heavy or irregular, if your symptoms are affecting your mental health or daily life, or if you're not sure your symptoms are related to perimenopause. Your GP can check for other health conditions that cause similar symptoms, such as an underactive thyroid. Blood tests aren't usually needed to confirm perimenopause if you're over 45, but they can help rule out other causes.

Taking menopausal hormone therapy (MHT), previously known as hormone replacement therapy (HRT), is the most effective treatment for hot flushes and night sweats, and it also helps with vaginal dryness. If lifestyle changes aren’t giving you enough symptom relief, your GP can help you decide whether MHT is right for you. Nourishing your body, staying active and supporting your sleep can also play a role in managing symptoms alongside medical care.

You can still see your GP or hormone specialist while receiving support from Floralia. We can discuss treatment options with you, including herbal medicines, and work alongside your other healthcare providers. The Australasian Menopause Society also has information about medical treatments.

Naturopathic support for perimenopause at Floralia

Your first perimenopause consultation gives your naturopath time to get a clear picture of what’s been happening. You’ll talk through your symptoms and cycle, along with your sleep, diet, stress levels, current medicines and medical history. If testing could provide useful information for your treatment, they may also recommend functional hormone testing.

There’s no one-size-fits-all approach to perimenopause. The right support for you will depend on your symptoms, lifestyle and individual needs. This might include herbal or nutritional support, alongside practical changes to your diet, sleep and daily routine. If you’re already receiving medical care, Floralia’s naturopaths can work alongside your doctor to support a more holistic approach.

You don’t need to be based in Perth to see us. You’re welcome to visit our Nedlands clinic in person, or connect with a Floralia naturopath via Zoom or phone from anywhere in Australia.

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Frequently asked questions about managing perimenopause naturally

Can you reverse perimenopause naturally?

Perimenopause can’t be reversed with food, herbs or supplements. It’s a stage your body goes through naturally. That doesn’t mean you simply have to put up with the symptoms, though. Natural care may help reduce the severity of symptoms like hot flushes or disrupted sleep while those hormonal changes are happening.

What should you avoid during perimenopause?

What to limit during perimenopause can vary from person to person, depending on your symptoms and how your body responds. You might tolerate coffee well but notice that alcohol makes your hot flushes worse. Skipping meals or exercising intensely without enough food can also leave you feeling depleted. Smoking is best avoided for your overall health, and it’s worth being mindful when combining herbal supplements, as some may contain overlapping ingredients or interact with prescription medications.

How does cortisol affect perimenopause?

Ongoing stress and disrupted sleep can affect how you feel during perimenopause, potentially making hot flushes and low mood harder to manage. Revisiting the stress management and sleep strategies outlined earlier in this guide can be a helpful place to start.

Can acupuncture help perimenopause symptoms?

The research on acupuncture for perimenopause symptoms is still developing, and results can vary between individuals. While evidence for its effectiveness in reducing symptoms such as hot flushes remains limited, some women find acupuncture helpful for relaxation and overall wellbeing. At Floralia, acupuncture can be considered as part of an individualised approach to supporting you through perimenopause.

How long does perimenopause last?

About 4 to 8 years on average, according to healthdirect. You reach menopause 12 months after your final period.

What are signs perimenopause is ending?

Your periods usually spread further apart, then stop altogether. The menopausal transition ends at menopause, which is confirmed once you’ve gone 12 months without a period.