Hormone imbalance or Perimenopause?

If you’re a woman who uses the internet and social media, you’ve likely been hearing A LOT about perimenopause. If you’ve gone to your PCP or OBGYN with hormonal concerns, you may have been told that you are in perimenopause. And if you’re more confused than ever about what it all means and what to do about it, you’re not alone. Likewise, if you feel totally unsupported or like your only option for treatment is birth control, you’re also not alone. 

Perimenopause means ‘the time before menopause.’ It usually starts about 4 years before a person has their last period. The average age for this is 47 years, but it can happen up to 10 years before the last period. Symptoms can include but are not limited to fatigue, joint/ muscle pain, headaches or migraines, hair thinning or loss, dry skin, changes in body composition, hot flashes, vaginal dryness, pain with sex, recurrent UTIs, bloating, breast tenderness, fluid retention, weight gain, worsening PMS symptoms, mood changes, brain fog, sleep disturbances, irregular periods, painful periods, heavy periods. Woof. That's quite the list.

Many of my patients come to me after having been told that their unpleasant symptoms are due to perimenopause, and they have two options: deal with it or take birth control. I’ve seen patients as young as their late 20s be told they are “probably just in perimenopause” and then swiftly offered birth control. Some of these patients have just finished telling their doctors they are interested in becoming pregnant. If this has happened to you and you feel in your gut that you could do more to support yourself during this time, you’re right! Nobody has to just deal with a collection of unwanted symptoms that can last up to 10 years, followed by everything that can come along with actual menopause! You deserve more information, answers to your questions, and a treatment plan that can make you feel like yourself again. 

So- is it a hormone imbalance or am I in perimenopause? This is one of the most common questions I hear from patients. And honestly, from a naturopathic perspective, the answer is often: it doesn’t really matter.

Whether you're officially in perimenopause or simply dealing with a hormonal imbalance, my approach doesn’t change. I’m not here to assign you a label—I’m here to help you feel better in your body.

What matters most is understanding what’s driving your symptoms, what your body is asking for, and how we can support your hormonal system holistically.

In my practice, there’s no one-size-fits-all plan. Every woman’s hormones, history, lifestyle, and needs are different, and your care should reflect that.

Here’s the good news:

Perimenopause represents a time of transition. A lot is changing in the body, including what the body needs to thrive. It’s an amazing time to listen to your body and take the opportunity to prioritize your health. By doing so, you can prevent chronic disease and unwanted metabolic changes. Likewise, if you’re experiencing some hormonal shifts and are not in perimenopause, your body is trying to talk to you. It’s so true that our cycles are our fifth vital sign. When they are off, we need to look deeper. So if you start to notice a shift, don’t worry too much about putting a label on it. Instead, work with a doc who can listen and develop a plan individualized for your needs. 

Here’s how we build a personalized foundation for hormone healing:

💤 1. Prioritizing Sleep

Quality sleep is where your hormones do much of their repair work. Without it, everything else—from cortisol to insulin to progesterone—gets thrown off. We assess your sleep hygiene, nighttime routine, and address root causes of disrupted sleep (like blood sugar crashes or nighttime cortisol spikes).

🥦 2. Nutrient-Dense, Hormone-Friendly Nutrition

You don’t have to follow a restrictive diet to support your hormones—but you do need to fuel your body with the right building blocks. We focus on balancing blood sugar, increasing fiber and healthy fats, and reducing inflammatory foods that interfere with hormone function.

🧘‍♀️ 3. Stress Management & Nervous System Support

Perimenopause symptoms are often worsened by chronic stress and an overactive HPA axis (your brain-adrenal connection). We use a combination of adaptogenic herbs, breathwork, boundaries, and nervous system tools to help you feel grounded and resilient.

🏃‍♀️ 4. Movement That Works for Your Hormones

The days of punishing workouts and under-eating are behind us. I help you find movement that supports your cycle—whether that’s strength training, walking, yoga, or something else entirely. The goal is to keep stress low and muscle mass high.

🌿 5. Targeted Hormone Support When Needed

In my practice I lean on a combination of symptom presentation and lab results. There is a time and a place for testing through blood work and doing more comprehensive hormone testing like the DUTCH test. The DUTCH tells us more about whether or not you have a hormone imbalance but can also tell us how your detox pathways are moving, if you’re using more inflammatory pathways, how your adrenals are functioning and so much more. If testing reveals imbalances in your sex hormones- like estrogen, progesterone, DHEA, or testosterone, we use herbs, nutrients, and lifestyle shifts to gently guide them back into balance. Sometimes we’ll incorporate bioidentical hormones, but always with careful monitoring and only when truly needed.

6. Support gut health

What does gut health have to do with hormonal health? Everything. Our gut is responsible for removing excess hormone metabolites from the body. A number of issues with our gut health can cause us to reabsorb those metabolites, which only further contribute to hormone imbalances and can be more harmful that the original hormone. 

You Don’t Have to Suffer Through This Alone

Perimenopause is not just “PMS on steroids.” It’s a dynamic transition that impacts your mood, metabolism, memory, and sense of self. You deserve to feel supported—not dismissed or told it’s “just aging.”

If you’re feeling overwhelmed, exhausted, or just not like yourself lately, know that your symptoms are real, and that healing is possible.

You don’t need to wait until your period stops to start taking care of your hormones. In fact, now is the best time to begin.

💬 Ready to Reclaim Your Hormonal Health?

If you suspect you’re in perimenopause or dealing with hormone chaos, I’m here to help. Together, we’ll create a personalized roadmap to support your body through this transition, rooted in holistic healing, evidence-based naturopathic care, and deep listening.

Because you deserve to feel your best in every stage of womanhood.

Dr. Nicole Kearney is a naturopathic doctor and women’s hormonal and gut health expert practicing in Burlington, Vermont. She provides health coaching to clients nationwide via telehealth. She has been in practice for over 10 years and is dedicated to helping women feel heard and find their way back to optimal health. To learn more, click here.