Developing Integrative Treatment Protocols for Perimenopause Symptoms


As a traditionally trained OB/GYN now practicing functional gynecology, Wendy Warner, MD, is used to treating women struggling with symptoms of perimenopause and menopause. Between working, taking care of the kids, and keeping up the household, women in their 40s and 50s often aren’t prioritizing self-care. But for patients who are becoming symptomatic, Dr. Warner says if they’ve never taken care of themselves, now is the time to start.

Before meeting with her patients, Dr. Warner, who works at a collaborative holistic medical practice in Philadelphia, has a health coach or nutritionist do a patient intake to detail their health history, current symptoms, diet, and lifestyle. During the patient’s actual visit, Dr. Warner asks more specific questions about not only their physical symptoms but their stressors, lifestyle, and emotional well-being, all of which could be contributing to their health problems. 

According to Dr. Warner, integrative care plans for perimenopause usually include:

Dietary Changes: Dr. Warner will have her patients work with a health coach to introduce more vegetables and reduce excess carbs. She says this change is crucial for hormone production and managing blood sugar levels, especially given the impact of cortisol on insulin.

Sleep Hygiene: It’s important to reduce screen time before bed and create a calm environment for better sleep. For persistent insomnia or brain chatter, Dr. Warner often recommends herbal remedies like lemon balm, milky oat top, and passionflower.

Personal time and Delegation: For patients experiencing perimenopause and menopause, Dr. Warner encourages self-care time, even if it’s a short period before bed. Depending on their family dynamics and beliefs, this might involve delegating tasks to family members or hiring help for household chores.

Physical Activity: Regarding exercise, Dr. Warner likes to gently incorporate physical activity into her care plans to help with muscle mass and blood sugar stabilization. The focus is making time for solitary, non-multitasking activities, like walking, to provide mental relaxation.

Stress Management: Dr. Warner oftentimes introduces patients to the concept of coherence and balance in the nervous system through the practices taught by the Institute of Heart Math. These techniques involve breathing and actively creating positive emotions to rebalance stress hormones.

Supplements: Certain supplements can be beneficial for patients going through perimenopause. Supplements Dr. Warner recommends several supplements such as,

  • Chasteberry: helps improve progesterone production and helps stabilize periods and mood swings.
  • Siberian Rhubarb Extract: helps reduce hot flashes through a slight increase in estrogen.
  • Herbal Supplement for Blood Sugar: a combination of herbs such as bitter melon and fenugreek powder can help improve blood sugar regulation.
  • Maca: can help support adrenal function.

Editor’s Note: This text was initially published in the e-book, Addressing the Root Cause of Perimenopause Symptoms. To read the full case study, click here.