If you're a woman, at a certain age you'll start to go through perimenopause followed by menopause. But what is perimenopause? How can you treat the symptoms without having a lot of unwanted side effects? Luckily for you, we're going to go over several natural remedies for perimenopause. We'll also explain why you want to avoid more traditional measures with synthetic hormones, and much more.

Understanding Perimenopause

Another name for perimenopause is the menopause transition. This typically starts several years before a woman goes through menopause, typically around the early 40s, but it can start in the late 30s as well. During this time, your ovaries produce less estrogen and progesterone. Perimenopause lasts up until you start to go through menopause. The average length of perimenopause is four years, but it can last for over a decade. In the last year or two of perimenopause, your estrogen and progesterone production levels will drop dramatically. When this happens, you transition out of perimenopause and into menopause. Throughout the process, you can experience night sweats, breast tenderness, fatigue, irregular periods, mood swings, urinary leakage, trouble sleeping and vaginal dryness. Your doctor can diagnose perimenopause based on the symptoms you experience. They can also perform blood tests to check your hormone levels. However, your hormones fluctuate during this time, so it may be beneficial to get several blood tests for comparison. Perimenopause officially ends when you go 12 consecutive months without having your period. Then you enter active menopause. (1)

Conventional Perimenopause Treatments

Over the years, physicians have come up with several conventional perimenopause treatments. They involve synthetic hormones for the most part. While they do work, they also come with unfortunate side effects that many people want to avoid. These side effects can even make your original symptoms worse, and they can wreak havoc on the rest of your system. Conventional perimenopause treatments include:

Hormone Replacement Therapy (HRT)

In its simplest form, hormone replacement therapy is taking medications that contain female hormones to replace the hormones your body no longer produces. Many women use HRT to help combat the common symptoms that come with perimenopause and menopause. (2) Hormone replacement therapy does come with side effects and risks. The exact amount of risk you put yourself at depends on the dosage and type of hormone you take. However, broad category risks include heightened cancer risks, stroke and cardiovascular events. (3)(4)(5)

Contraceptive Pill

The contraceptive pill is an oral form of birth control that you take once daily. They come in two types ranging from progestin-only to a mixture of estrogen and progestin. The contraceptive pill's main use is to prevent pregnancy. They do this by restricting your estrogen levels and preventing your body from releasing an egg. They can also help level out your hormones and prevent them from having large fluctuations that can cause discomfort. (6) There are a few health complications associated with taking the contraceptive pill. One of the most common is developing high blood pressure. In turn, this can increase your risk for developing cardiovascular issues like stroke, heart attack or blood clots. (7)(8)

Vaginal Estrogen

Vaginal estrogen is another way women introduce estrogen back into their systems. You can get it as a vaginal ring, cream or tablets. They come designed to help with itchiness, vaginal dryness and pain or burning during intercourse. Since you insert them, they get directly into your system. If you want the vaginal ring, your physician typically has to insert it depending on the brand. (9) Like any other synthetic hormone replacement, vaginal estrogen comes with potential side effects that can worsen in severity the longer you take them. The more common side effects include things like nausea, vomiting, weight changes, lumps in your breasts and dark areas on your skin. More serious symptoms include pulmonary embolism, stroke and heart attacks. (10)(11)

Gabapentin (Neurontin)

Gabapentin is a prescription drug that comes as an immediate-release oral tablet. You can also get extended-release tablets. It's popular for women who experience more severe perimenopause symptoms like hot flashes. The drug also works to improve overall sleep quality if you take the extended-release tablets. (12) As with any medication, it has both severe and non-severe side effects, and they range from person to person. You can experience nausea, fever, and weakness. More severe symptoms include slurred speech, jerky movements, hostility, blood clots, strokes or other cardiovascular episodes. The more mild side effects tend to go away after a few weeks. (13)

7 Natural Remedies for Perimenopause

If you want relief from your perimenopause symptoms, but you don't want to experience the side effects of conventional treatments, you can opt instead for the natural route. We've rounded up seven natural remedies for perimenopause, and we'll outline what they can do for you and why they work so well.

1. Chasteberry

Chasteberry, or vitex agnus-castus, is a relatively new supplement, but it's native to central Asia's Chaste trees. There is a long history of using chasteberry to help with perimenopausal symptoms because it has direct impacts on hormones like estrogen and progesterone. There isn't currently a lot of hard research surrounding the use of chasteberry because it's newer to the mainstream supplement world. However, the results are promising so far. (14) In Australia, the Royal Melbourne Institute of Technology set out to find out how effective chasteberry was on perimenopause by analysing 12 randomised trials. Eight of the 12 trials focused on perimenopause, two focused on premenstrual dysphoric disorder, and two focused on hyperprolactinaemia. Out of these eight trials, seven of them had results that proved using chasteberry worked better for controlling perimenopause symptoms than the placebo did. (15)

2. Maca Root

Maca root goes by the more well-known name of Peruvian ginseng. Indigenous people of the Andes region have utilised maca root for centuries to help heal several common health problems. Most commonly, there is a long history of using it for infertility, hot flashes, sleep disruptions, night sweats and sexual dysfunction. (16) One double-blind study took 20 women who were reporting issues with their perimenopause symptoms. These outpatients reported feeling discomfort, and many of them had night sweats or hot flashes. The researchers split the 20 women into two groups of 10. Each group got blood tests before the beginning of the trial to measure their levels of estrogen and progesterone. The women in group A got 500mg of maca root while the women in group B got a placebo twice every day. Researchers took another blood test at the end of the study to test the women's hormone levels. They found that group A had far more regulated hormones than the women in group B. They reported having fewer night sweats, hot flashes and discomfort as well. (17)

3. Rhodiola Extract

Rhodiola rosea is a plant that you find naturally growing in the cooler mountainous regions of Europe and Asia. There are over 140 active ingredients in rhodiola extract, and this extract helps your body handle stress. People living in Russia and Scandinavia have utilised this plant for centuries to fight fatigue, depression and anxiety. It has a positive impact on oxidative stress and hormonal biomarkers that can reduce inflammation and balance your hormones. (18) One Russian study demonstrated rhodiola extract's effectiveness in helping regulate perimenopause hormone levels. In the study, 40 women volunteered who were experiencing hormone fluctuations and irregular menstrual cycles. The women got a dose of this extract by mouth in tablet form or by injection once a day for two weeks. At the end of the two weeks, 25 participants had normal menstrual cycles out of the 40 original participants, and 11 got pregnant. (19)

4. Berberine

Berberine is a popular medicinal plant in ancient Indian and Chinese medicine. It comes with a natural alkaloid that you can find available in several different classes of herbs. You can find this alkaloid in berberine's stem, roots, rhizomes and bark. Recently, berberine has become very popular for use as a supplement to help balance out hormone levels. It does this by travelling to your cells and binding molecules. When it does this, it changes how they function just like traditional pharmaceuticals do. (20) Berberine is effective for combating the common symptoms associated with perimenopause and lowering your chances of developing worse health problems like cardiovascular disease and inflammation. Inflammation can make your perimenopausal symptoms worse. A study found that women showed significantly lowered inflammatory markers in their blood after they began taking berberine compared to control groups. It can also help regulate mood and and hormone levels. (21)

5. Black Cohosh

Black cohosh is a perennial herb that is part of the buttercup family. It goes by several names including snakeroot, rattleweed and bugbane. You'll find it growing wild in the eastern part of North America. For centuries, Native Americans have utilised black cohosh to treat perimenopause symptoms, to ease childbirth pain and for irregular menstrual cycles. Since the 1950s, it's been popular as a short-term supplement. (22) One study sought to see if black cohosh was effective for treating hormone fluctuations in both perimenopausal and postmenopausal women. Researchers started by taking blood tests to determine hormone levels. Over a period of 24 weeks, the two random groups got 39 mg and 127.3 mg of black cohosh every day. At the end of the 24-week trial, blood samples measured the hormone levels again. They found that both groups had improved symptoms with 70% and 72% reporting improvements, but the dosage amount didn't seem to factor in. (23)

6. Inositol

Inositol is a carbohydrate that you can naturally find in your body, and you'll also find it in a lot of dietary supplements. This molecule comes in several different forms, but they all have a chemical structure that is very similar to glucose. It plays a critical role in several different bodily processes, and there has been a lot of study into the potential health benefits associated with it. It can help with anxiety and fertility problems. (24) One study took 40 women who were in active perimenopause and split them into two groups of 20. Over the course of the six-month trial, group A got 2g inositol twice a day, and group B got 2g inositol plus 3g melatonin twice a day. They evaluated the women for hormone levels and indicators before and after the trial. At the end of the trial, both groups showed positive improvement in their hormone levels and thyroid function. (25)

7. Probiotics

Probiotics are live yeasts and bacteria that are good for your health. They provide you with a host of health benefits when you incorporate them into your diet. You can take them as supplements to help to colonise your gut bacteria, but they also have strong links to helping with perimenopause. (26) There are colonies of bacteria that live in your gut and your vagina that help to keep your menstrual cycle regular. As you start perimenopause, the decline in your estrogen levels can lead to vulvovaginal atrophy, and this can cause itching, burning, painful urination and dryness. One study took 90 women and split them into groups of perimenopause, menopause and post-menopause. They measured the bacteria levels and introduced Lactobacillus bacteria via probiotics. At the end of the study, all three groups reported improved vulvovaginal atrophy. (27)

Side Effects and Safety

Luckily, there are very few side effects associated with these natural remedies for perimenopause. The side effects that people did report were mild, and they tended to fade after a few weeks. The most common side effects were nausea, headache, rash, upset stomach and some minor spotting or bleeding. However, it's essential that you consult with your physician to be safe before you introduce any of these natural remedies for perimenopause into your diet. Your physician will be able to tell you whether or not it can interact badly with your system or other medications you are on. If they give you the go-ahead, you can try them and see which one works to help with your perimenopause symptoms.