An Herbalist’s Guide to 19 Common Perimenopausal Symptoms & Treatment
Perimenopause is a season of change that can last 8–10 years before your final menstrual cycle.
For some, it’s smooth sailing. For others, symptoms like heavy bleeding, hot flashes, insomnia, and heart palpitations can be overwhelming.
Functional medicine teaches us to view these symptoms as signals, not random annoyances. By supporting the body with herbs, diet, lifestyle shifts, and hormone balance, you can make this transition more graceful.
As herbalist Susun Weed says:
“Menopause is not a disease. It’s a natural process of life. The joy of menopause is the world’s best-kept secret.” (Weed, 2002)
Below, I’m sharing nineteen common perimenopausal symptoms with natural treatment strategies from both traditional herbalism and functional medicine.
Perimenopause Natural Remedies
1. Perimenopause Bleeding
The first thing many women notice is a heavier cycle, sometimes with extreme blood clots. These clots can drop iron levels dramatically, leading to fatigue, dizziness, and more.
If you’re also living in a mold-contaminated home, it affects your hormones by increasing your estrogen. Mold exposure can raise estrogen levels and worsen clotting, especially for women with the MTHFR gene variant.
What to do:
Inspect for mold and remediate thoroughly. Read this post to learn more.
Run a DUTCH hormone testto assess estrogen/progesterone balance.
Consider bioidentical progesterone during cycle Days 14–28. In my experience, this, combined with mold removal, reduced the clots so I can learn how to manage my body.
Add Vitamin D + K2 for healing.
Blood Clots: How to Treat?
If you have large or frequent clots:
Check for environmental toxins like mold.
Support iron levels through diet (grass-fed beef, liver, leafy greens) and supplementation if needed.
Balance hormones with practitioner guidance. Progesterone often plays a key role in clot resolution.
Add in Vitamin D + K2 for support
Herbs to consider:
Vitex Chaste Berry
CAUTION can cause depression in those low in oestrogen
DIM/I3C
Yarrow Tea
Shepherd’s Purse
Consider topical bioidentical progesterone
Use Day 14–28 at night
Work on metabolizing estrogen
May be a Vitamin K deficiency
==Learn more about blood clots here:https://www.taragregorio.com/blog/blood-clots-fibroids-and-bio-identical-progesterone
2. Bloating and sugar cravings
Could be from SIBO
small intestinal bacterial overgrowth
Yeast
Too much progesterone creates more yeast
H. pylori
Associated with high acidity in the body
Low stomach acid
This is very common! Add in Hydrochloric acid and digestive enzymes to support digestion
Increase potassium
3.Fast Constipation Remedy
½ cup coconut water {potassium} + salt + whole food Vitamin C
OR ½ orange juice (fresh squeezed if possible/Vitamin C) + ⅛ tsp cream of tartar (for potassium) +⅛ tsp sea salt (for sodium + adrenals
Optional: a dash of magnesium glycinate powder
====See more constipation remedies here: https://www.taragregorio.com/blog/10-ways-to-reduce-constipation?
4. High Blood Pressure
Hypotensive herbs
Garlic
Yarrow, Hawthorne, and Vervain
Limit alcohol, salt, and oils
Reduce constipation
6.Vaginal Dryness
From low estrogen, thinning mucosa, and lowered elasticity
Herbs to consider:
Dong Quai
Shatavari
Licorice root
Drink a quart of red clover weekly {Susan Weed - master herbalist}
Vaginal suppositories
Bezwecken - Estriol {may help reduce UTI recurrence}
7. Decreased Libido
Linked to lower estrogen/testosterone, dryness, and mood
Herbs:
Maca
Damiana
Ginseng
Shatavari
You may have low testosterone
8.Low iron
Add nutrient-dense iron sources
Beef liver capsule - every other day
Grass-fed red meat
Additionally you need
HCl - hydrochloric acid
bitters
digestive enzymes
so you actually ABSORB the iron
Biotin helps with this as well
Lower high estrogen to stop excessive bleeding
9. Weight Gain & Abdominal Fat
Declining estrogen shifts fat distribution to the belly
Contributes to insulin resistance and inflammation
Herbs to consider:
Nettles (water retention + minerals)
Green tea (metabolism)
Cinnamon
Gymnema sylvestre (blood sugar balance), Berberine {2 weeks then take a break}
Lifestyle: Resistance training + protein + sleep
10.Cholesterol
This happens because estrogen helps the liver process fats and remove cholesterol from the body.
Work on thinning the bile sludge...
Liver /gall bladder support includes
Milk Thistle
Schisandra
Dandelion Root
Castor oil pack
Tudca - bile acid, breaks down fats
Coffee enemas + Tudca
11.Joint Pain & Inflammation
Estrogen decline reduces anti-inflammatory protection
Herbs to consider:
Turmeric/Curcumin,
Boswellia
Ginger
Nettle leaf
Lifestyle: Sauna, gentle movement (water exercise), anti-inflammatory diet
remove all gluten and dairy
Check for Epstein-Barr Virus
Increase Omega-3s
Topical bioidentical estriol may help here; osteoarthritis is associated with low estrogen. [3]
12. Hair Loss
Possible Root Causes
Malnutrition, low protein, check iron/thyroid
Heavy metals are stored in the cranial cavity
Mold or candida in the sinus cavities
Anemia, Lyme disease
Estrogen dominance or high androgens (testosterone, DHT conversion)
Blood and iron loss
Solutions
Add Saw Palmetto to block DHT (androgen), spearmint tea
13. Perimenopause Heart Palpitations
Palpitations can stem from low estrogen, high histamine, or even magnesium deficiency.
Herbs to support heart rhythm and calm the nervous system:
Motherwort – 10–30 drops tincture up to 3x/day.
Hawthorn – strengthens heart muscle and vessels.
Lemon Balm – mild calming effect, especially for anxiety-linked palpitations.
Black Cohosh – especially if palpitations coincide with hot flashes.
==See more anxiety remedies here: https://www.taragregorio.com/blog/natural-remedies-for-perimenopause-anxiety-without-medication
14.Natural Remedies for Perimenopause Hot Flashes
Hot flashes affect up to 75% of women during perimenopause. They often correlate with liver health and cortisol spikes.
Lifestyle steps:
Remove alcohol to lighten liver load.
Ensure drainage pathways are open, sweating, hydrating, and eliminating 1–2x daily.
Manage stress with breathwork and gentle movement.
Herbal allies:
Motherwort
Sage
Black Cohosh
Red Clover (phytoestrogen source)
15. Perimenopause Rage & Emotional Swings
Emotional surges, especially anger-triggered hot flashes, point toward liver support needs in both Traditional Chinese Medicine and functional medicine.
Helpful herbs:
Milk Thistle (liver detox support)
Schisandra Berry (adaptogen + liver tonic)
Lemon Balm (calming and digestive aid)
16.Mood Swings, Anxiety, Depression
Due to low serotonin/GABA, fluctuating estrogen/progesterone
Herbs to consider:
Motherwort
St. John’s Wort
Albizia - happiness bark
Damiana
Nutrients:
GABA - neurotransmitter
L-theanine- non-protein amino acid found in green tea
5-HTP is a chemical that your body makes from the amino acid L-tryptophan, a precursor to serotonin
17.Brain Fog & Memory Issues
Low estrogen impacts cognition and neurotransmitters
Check gut health
Herbs to consider/nootropics:
Ginseng (energy & memory)
Gotu Kola (focus)
Rosemary tea (circulation to the brain)
Rhodiola
Lion’s Mane mushroom
BHRT estrogen can help here
18. Natural Remedies for Perimenopause Insomnia
Sleep struggles can be hormonal, stress-related, or both.
First, look at your daytime habits: caffeine intake, screen exposure, and evening stress.
If progesterone is low (confirmed by DUTCH test), bioidentical supplementation on Days 14–28 can be life-changing.
Herbal sleep aids:
Skullcap
Motherwort
Lavender
California Poppy
Kava Kava
Valerian Root
19.Perimenopause Urinary tract infection {UTI} Treatment
Painful urinary symptoms aren’t always an infection; they can be low estrogen or a microbial imbalance.
Testing tips:
Start with a standard UTI test. If negative, request a UroKey test (MicrogenDX) to detect hidden pathogens.
Consider DUTCH testing to check estrogen status.
If estrogen is low:
Vaginal suppositories with estriol (2x/week).
Topical bioidentical estrogen as needed, balanced with progesterone to prevent excess estrogen effects like clots or breast tenderness.
===See more UTI remedies here: https://www.taragregorio.com/blog/7-steps-to-stop-a-uti-naturally
Where to begin? Are you overwhelmed?
What to do
Write down the #1 most pressing symptom
Write down your diet & supplements
Get your blood drawn
Even though your numbers “are fine.”
Keep in mind, our doctors are looking for when we’re sick, not optimal health
I look at functional medicine optimal numbers, NOT conventional
Let’s create a customized, personalized protocol for you.
Closing Thoughts
Perimenopause can feel like uncharted territory, but with the right tools, it’s navigable. Herbs, lifestyle shifts, environmental awareness, and hormone support create a powerful toolkit.
This season is also an opportunity to reclaim time for yourself to lift heavy weights, rest deeply, and listen to your body’s messages.
Ready to learn more?
Book a private health consultation for natural support from a certified herbalist. Book it here.
xo
Tara
More Reading
https://www.taragregorio.com/blog/blood-clots-fibroids-and-bio-identical-progesterone
https://www.taragregorio.com/blog/how-to-detect-mold-toxicity-in-your-body-and-home
References
Mayo Clinic. (2024). Perimenopause: Symptoms & causes.
Institute for Functional Medicine. (2022). Functional Medicine Approach to Perimenopause.
National Institutes of Health. (2021). Hot flashes and hormone changes.
Shoemaker, R. (2018). Mold Illness and CIRS: Diagnosis and Treatment.
