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“Is This Perimenopause… or Am I Losing My Mind?”

perimenopausal women
with Dr. Katie Rothwell, ND

A Naturopathic Doctor’s Guide to Understanding the Menopause Transition & What Perimenopause Support Looks Like

Waking up sweaty. PMS on steroids. Feeling anxious, exhausted, and wondering, “What is happening to me?” Do I need perimenopause support?

If any of this sounds familiar, you might be in perimenopause—the hormonal rollercoaster that often starts in your late 30s or 40s. And no, you’re not crazy. You’re not failing. You’re transitioning. You need perimenopause support.

As a licensed Naturopathic Doctor with over a decade of experience guiding women through perimenopause and menopause, I’m here to offer evidence-based support, rooted in both science and compassion.

Let’s clear the confusion and talk about what’s really going on—and how you can feel like yourself again.

Meet Jen: A Story That Might Sound Like Yours

At 44, Jen walked into my office completely drained. She was waking up every night soaked in sweat, snapping at her family, gaining stubborn weight, and dealing with anxiety that seemed to come out of nowhere.

Her doctor offered antidepressants and told her to “wait it out.”

But Jen wasn’t just stressed—she was in perimenopause, and her body was begging for support.

With personalized care that included lab testing, nutrition support, lifestyle shifts, and eventually Menopausal Hormone Therapy (MHT), Jen got her energy back, improved her sleep, and finally felt at peace in her body again.

This story isn’t rare. It’s real. And you deserve this kind of care, too.

So… What Exactly Is Perimenopause?

Perimenopause is the transitional phase before menopause, typically starting between ages 35 and 50, though the timing varies widely.

It’s marked by fluctuating estrogen and progesterone levels—think hormonal chaos – it’s not just a smooth and steady decline.

It can last anywhere from 4 to 10 years, and symptoms are often mistaken for stress, aging, or mental health issues.

Menopause, by contrast, is a single point in time—defined as 12 consecutive months without a menstrual period. After that, you’re considered postmenopausal.

Top Symptoms of Perimenopause

Perimenopause can affect nearly every system in your body. Some of the most common symptoms include:

  • Hot flashes and night sweats

  • Mood swings, anxiety, or depression

  • Irregular or heavy periods

  • Sleep disturbances

  • Brain fog and poor memory

  • Low libido or vaginal dryness

  • Fatigue and burnout

  • Weight gain (especially belly fat)

  • Hair thinning or dry skin

  • Joint aches and headaches

You might experience all of these—or just a few. The key is recognizing the pattern.

How Is Perimenopause Diagnosed?

Contrary to popular belief, there’s no single test that diagnoses perimenopause.

As a naturopathic doctor, I use a comprehensive clinical assessment which may include:

  • A deep-dive symptom history

  • Menstrual tracking

  • Targeted hormone testing if indicated (however this is NOT needed for most women) such as FSH, LH, estradiol, progesterone

  • Thyroid panel (many women have thyroid changes at midlife)

  • Metabolic testing like glucose, insulin, and cholesterol

  • Ruling out other causes of your symptoms like anemia,  nutrient deficiencies or anxiety/depression.

Diagnosis is about connecting the whole picture, not chasing a lab number.

So… What Can You Do About It?

Let’s break down your treatment options—based on both science and real-world results.

1. Nutrition & Diet

Food is foundational. During perimenopause, eating to support hormone balance, blood sugar stability, and inflammation can make a massive difference.

  • Focus on: Whole foods, veggies, legumes, healthy fats (hello, olive oil!), lean protein, and plenty of fiber. A Mediterranean-style diet is one of the most studied and effective patterns for hormone health and longevity.

  • Minimize: Sugar, refined carbs, processed foods, and alcohol

  • Bonus! Include phytoestrogens: like ground flaxseed, tofu, and edamame

2. Lifestyle Strategies

  • Move regularly: Strength training and walking support bones, metabolism, and mental health

  • Prioritize sleep: Set up a consistent routine, cool your room, and limit screens

  • Manage stress: Use breathwork, meditation, and restorative practices to calm the nervous system

  • Strengthen relationships: Connection and community are protective during this time

3. Perimenopause Support with Menopausal Hormone Therapy (MHT)

When used appropriately, MHT is safe, effective, and life-changing for many women.

  • Most beneficial if started before age 60 or within 10 years of menopause

  • Helps with hot flashes, sleep, mood, vaginal dryness, and more

  • Transdermal Estrogen, oral/vaginal progesterone, as well as low dose vaginal estrogen are all therapeutic options. Note: I follow the latest guidelines from the North American Menopause Society (NAMS) to ensure MHT is personalized and safe. 

  • To learn more about MHT you can read about it here 

4. Targeted Supplements & Herbs

Supplements are never one-size-fits-all, but they can be powerful when chosen strategically:

  • Magnesiums / Melatonin : Calms the nervous system and supports sleep

  • Vitamin D3: Boosts bone health, mood, and immune function

  • B vitamins: Support energy, mood, and neurotransmitter balance

  • Iron: to restore low iron levels (which is incredibly common with the unpredictable periods of perimenopause)

  • Herbs: Like ashwagandha and rhodiola for energy and stress support. Saffron and Maca for mood and libido support. And Black cohosh and sage to reduce hot flashes and night sweats.

Always work with a trained provider to get quality supplements at the right dose.

You’re Not Broken—You’re Evolving-You need Perimenopause Support

Perimenopause is a powerful, often messy transformation—but it’s not something to “suffer through.”

With the right tools, testing, and support, you can feel clear, calm, energized, and connected again.

Ready to Take Control of Your Hormone Health and get Perimenopause Support?

Let’s figure out what your body needs. Book an initial visit with Dr. Katie Rothwell, ND and let’s co-create your roadmap to thriving through perimenopause and beyond.

📅 Schedule your visit today
📧 Have questions? Reach out here info@rootedinhealth.ca

You deserve answers. You deserve options. And you don’t have to do this alone.

If you want to learn more about Menopause visit the Menopause Society of Canada – They do some great work!

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