Treatment Options for Perimenopausal Symptoms

Dr. Alexia Harris, ND


Despite menopause being a natural process of aging, the transitional period between the reproductive and menopausal years (known as perimenopause) is often not a smooth ride. During this transition, ovulation becomes irregular leading to fluctuations in hormone levels. Although, estrogen and progesterone (the main female hormones) levels decline in menopause, the perimenopause period is often marked by fluctuating and often elevated levels of estrogen. These hormone imbalances are typically responsible for the unpleasant symptoms associated with perimenopause such as irregular menses, hot flashes, night sweats, vaginal dryness, skin changes, fatigue, sleep disturbances, hair loss on the head, decreased libido and mood changes (Hudson, 1999).


There are a number of vitamins, minerals and botanical extracts designed to naturally balance female reproductive hormones and ease symptoms associated with the perimenopausal transition.

Here are descriptions of some of our top choices:

Chaste tree (Vitex agnus-castus)

Chaste tree (Vitex agnus-castus) is a botanical that has been widely studied and recognized for its actions on balancing the hypothalamus-pituitary-ovarian axis (HPO-axis), which is the neuroendocrine communication unit between the hypothalamus and pituitary gland in the brain, and the reproductive organs. One of Chaste tree’s proposed mechanisms of action is that it increases secretion of luteinizing hormone (LH) which then indirectly favours the production of progesterone. It is suggested that fluctuations in progesterone levels are responsible for the irregular bleeding seen in perimenopause. Whether the menstrual cycle becomes heavier, lighter, more frequent or less frequent, Chaste tree has been shown to help normalize the menstrual cycle when it is due to a relative progesterone deficiency, or a relative estrogen excess (Hudson, 1999) (The Naturopathic herbalist).


Black Cohosh (Cimifuga racemosa)

Black Cohosh (Cimifuga racemosa), which has been used extensively in Germany, and is the most widely studied natural alternative to hormone replacement therapy (Hudson, 1999). Based on clinical studies, Black Cohosh extracts have been shown to be effective at reducing not only, hot flashes and night sweats, but also vaginal dryness, and mood changes (Brucker, 1960).


Calcium D-Glucarate

Calcium D-Glucarate is a naturally occurring compound produced in small amounts by mammals and humans. It is also found in certain fruits and cruciferous vegetables. Oral supplements of calcium D-Glucarate have been shown to helps the body safely eliminate estrogens through liver detoxification making it useful for the regulation of estrogen metabolism thereby supporting healthy estrogen levels (Walaszek et al. 1986).


Diindolylmethane (DIM)

Diindolylmethane (DIM) is another naturally occurring compound derived from indole-3-carbinole (I3C) and is found in cruciferous vegetables. Like calcium-d-glucarate, DIM also plays a role in supporting healthy estrogen metabolism (Brignall, 2001).


Antioxidants and Phytoestrogens (EGCG and Trans-resveratrol)

Antioxidants protect the body from oxidative stress (free radical damage) which plays an integral part of the aging process and has been directly linked to the decline of estrogen during the menopausal transition. EGCG is an extract from green tea are has been widely studies for its potent antioxidant effects. It is added to this formula, along with trans-resveratrol for maximum antioxidant protection (Doshi et al. 2013).


Trans-resveratrol is a naturally occurring antioxidant compound found in several plants such as grapes, berries and other plant foods. Trans-resveratrol is produced by these plants in response to injury to protect them from pathogens. Apart from its beneficial actions as an antioxidant, studies show that trans-resveratrol also has both estrogenic and antiestrogenic actions, classifying it as a phytoestrogen (Bagchi et al. 2001).


Research shows that phytoestrogens work by binding to the body’s estrogen receptor sites and blocking the body’s own estrogen from binding. The effect of the plant estrogen is much weaker and thus lessens the actions of estrogen in the body. This anti-estrogenic effect can be beneficial in pre-menopausal women to treat cases of estrogen dominance (high levels of estrogen in the body). However, in peri and post-menopausal women, when estrogen levels begin to decline, phytoestrogens act as estrogen synergists because even the slightest stimulus from the plant compound is greater than nothing, helping enhance the body’s overall estrogenic activity (The Naturopathic herbalist).


Based on the phytoestrogenic effects of trans-resveratrol, it has become a popular natural treatment for balancing hormones in perimenopause and menopause.


Vitamins and Minerals

Vitamins B6, B12, and folate (B9) are essential nutrients for cellular and metabolic functions. Vitamin B6 is a particularly important vitamin when it comes to balancing hormones. Research shows that it helps boost progesterone levels and counteracts excess estrogen, a common hormone imbalance that occurs in the perimenopausal period.


Magnesium and calcium help support bone health and to promote healthy hormone metabolism though the liver.



Information can be empowering, but we all have unique health profiles and needs. The health-related information contained in this article is intended to be general in nature and should not be used as a substitute for a visit with a licensed naturopathic doctor. The advice in this article is not intended to provide medical advice, diagnosis or treatment. ​




  1. Bagchi, D., Das, D.K., Tosaki, A., Bagchi, M., and Kothari, S.C. (2001). Benefits of resveratrol in women’s health. Drugs Exp Clin Res. 27(5-6). Pp. 233-48.


  1. Brignall, M.S. (2001). Prevention and Treatment of Cancer with Indole-3-Carbinol. Alternative Medicine Review. (6)6, p. 583.


  1. Brucker, A. (1960). Essay on the phytotherapy of hormonal disorders in women. Med Welt. 44:2331-33.


  1. Calcium-D-glucarate. Altern Med Rev. 2002 Aug;7(4):336-9.


  1. Doshi, S.B. and Agarwal, A. (2013). The role of oxidative stress in menopause. J Midlife Health. 4(3): 140–146.


  1. Guilliams, T.G. (2001). Menopause: a natural transition. The Standard.4(1).


  1. Hudson, T. (1999). Women’s Encyclopedia of Natural Medicine: Alternative Therapies and Integrative Medicine. Keats. Lincolnwood, Illinois. Pp. 135, 137, 142.


  1. Walaszek, Z., Hanausek-Walaszek, M., Minto, J.P., and Webb, T.E. (1986). Dietary glucarate as anti-promoter of 7,12-dimethylbenz[a]anthracene-induced mammary tumorigenesis. 7:1463-1466.


  1. Zhang, C.Z., Wang, S.X., Zhang, Y., Chen, J.P., and Liang, X.M. (2005). In vitro estrogenic activities of Chinese medicinal plants traditionally used for the management of menopausal symptoms. J Ethnopharmacol. Apr 26;98(3):295-300.