The second installment of a five part series.

My preferred step by step approach to navigating the menopausal journey:

Step 1:

  • Eat a nutrient-rich diet, exercise regularly, stretch, rule out other medical problems (thyroid, serious ob/gyn issues through a visit with an ob/gyn doctor and blood tests), implement a de-stress routine, get good sleep,  aspire to a balanced lifestyle, and don’t smoke.  If you drink alcohol, experiment with giving it up for a week or so to see if that alleviates hot flashes, headaches and insomnia–some women over 40 find this really to help. (some of you may be rolling  your eyes)

Step 2:

  • After determining that you don’t have any medical complications and a doctor has ruled out other possible health conditions that can cause any of the symptoms you may be experiencing: try to fill any vitamin, mineral deficiencies by altering your diet or taking supplements if you can’t manage with diet alone.  Deficiencies can be found through blood tests and the help of an MD or a health care practitioner who interprets blood tests using what’s called functional blood analysis.

Step 3:

  • If diet and lifestyle aren’t enough, or you would like more support, try rebalancing your body through acupuncture, herbs, biofeedback, or other alternative treatment under the care of a licensed practitioner.

Step 4:

  • If after trying steps 1, 2, and 3 to the best of your ability and you still feel lousy,  by all means, try Hormone Replacement Therapy or HRT.  

In my 11/2/17 post “Introduction: Perimenopause and Menopause,” I alluded to the importance of your “well taken care of soil” for the smooth transition into menopause. Sounds like pretty good advice for everyone at every age, right?  But what more can we do during this transitional stage?   You may be asking yourself what exactly you should be eating or not eating to ward off fatigue, hot flashes etc….

I’m glad you asked…..let’s begin with step #1

Step #1:

  • Eat a nutrient-rich diet, exercise regularly, stretch, rule out other medical problems (thyroid, serious ob/gyn issues through a visit with an ob/gyn doctor and blood tests), implement a de-stress routine, get good sleep,  aspire to a balanced lifestyle, and don’t smoke.  If you drink alcohol, experiment with giving it up for a week or so to see if that alleviates hot flashes, headaches and insomnia–some women over 40 find this really to help. (some of you may be rolling  your eyes).

Chinese medicine is a holistic medicine so what follows may not seem to specifically pertain to perimenopause or menopause, but again, we are talking “soil”…the basis on which all health–or lack thereof–emerges from.  To repeat, some things are not within our control to change such as genetics, past traumas, and environmental exposures.  So, work with what you have to the best of your ability on every given day.

We are learning now that our obesity epidemic in America is in part due to the SAD, or Standard American Diet.  This diet tends to be of highly processed foods, with little fresh fruit, vegetables, fish, or legumes.  Not only does this set us up for obesity and its related increase in diabetes, cancer, heart health, etc, it means our body is working harder with less nourishing, higher calorie fuel….we are putting our bodies at a disadvantage as we age and are facing more health challenges.

In Chinese medicine, the first medicine is considered to be food. Traditionally, the Chinese start off the day with a rice porridge with various “medicinal” foods cooked in or added to it to address their constitution (ie. if they are old or weak or young or robust) and according to how they are feeling (say, if they have been exposed to someone with a cold/flu or are currently experiencing fatigue). So, traditionally, the Chinese eat mindfully by listening to their bodies’ needs and signals.  Second, the traditional Chinese diet is extremely varied and certainly more so than our Standard American Diet.  If you eat the same foods every day (say salad, chicken, and pilaf) you are supplying your body with the same combination of nutrients—blocking the uptake of the same nutrients and allowing the absorption of those same nutrients.  If you vary it, you are expanding the combinations of the foods and the nutrients offered, blocked, and/or absorbed. You are allowing, for instance, better absorption of an iron-rich food (calves’ liver) if you eat a food rich in vitamin C (say citrus fruit).  You also need dietary fat to absorb the fat soluble mineral calcium and vitamins E, K, A, and D.  A varied, nutrient-rich diet allows better chances of ensuring absorption of all of the required vitamins and minerals.  

Now, this might stress you out…now you have to think of “optimal food combinations” to maximize nutrient values on top of shopping, planning, cooking, and satisfying everyone that comes to your table.  Deep breath!  What I tell my patients is to do the best you can do each day and try and plan on rotating in some new foods or new combinations of foods.  It’s best to plan before you go shopping for the week!  Also my diet mantra: variety, variety, variety, moderation, moderation, moderation.  Food is a very real and accessible source of enjoyment (not to mention legal!)…so make sure you still enjoy eating!  If you eat birthday cake, don’t furtively eat three huge slices in the middle of the night while binge-watching a show.  Take a regular sized slice, sit down and enjoy each bite, chew slowly and savor it.  It’s better to enjoy the slice while in good company and certainly without disturbing tv or news going on in the background.  Don’t berate yourself before, during, or after you eat it, don’t rush through it, don’t distractedly raise the fork into your mouth while you are wondering why Game of Thrown took such a nasty turn.  Relish each bite and be thankful.  You’ll get far more satisfaction if you eat one piece slowly and mindfully than if you hurriedly eat three slices either mindlessly or racked with guilt and shame. You’ll body will probably feel better too! Again, eat in moderation and with variety.

If you want to read an article justifying this to a degree here you go:

Now then, what to eat:

The following table lists specific perimenopausal/menopausal symptoms and the vitamins and mineral that can help alleviate or lessen their severity.  This is not an exhaustive list, but it may give you some quick “go to” foods to feed your body optimally.  You can also look at my Pinterest board for some lists on specific foods for symptoms, honestly, it may be easier to follow than the below table:



peri-menopausal symptom vitamin/mineral Foods containing/lifestyle Avoid the following
Hot flash/night sweat
Phytoestrogen, “liver cleansing foods,” Vit B complex, Vit C, Vit E (400-800IU) take for 4-6 weeks to notice effects and vitamin E’s effectiveness may wear off after time, magnesium, potassium  
Soy, flaxseed, eat smaller more frequent meals, keep hydrated, exercise ½ hour daily, away from bedtime so as not to raised body temp. Before sleep Spicy foods, soy protein powder and supplements not recommended as they contain soy isolates (mess w/ hormone levels rather than benefit), avoid hot showers/baths and rigorous exercise just before bed, abstain from alcohol in hours before bed.  Avoid chocolate, hot drinks,caffeine, MSG, sodium nitrate (found in some lunch meats, bacon,etc), sulfites 9red wine, dried fruits, cheddar cheese)
Hair thinning, dry
Omega 3, selenium, protein
Good fat, brazil nuts, vegetable protein, good hair care practices/products
Ask your hairstylist for hair care products and styling do’s and don’ts.
cramps Magnesium, Vit C, A, E, D,  vitamin B complex, omega 3 Leafy greens, fish, flaxseed, raspberry leaf tea, ginger tea (if your bleeding isn’t heavy) hormone-free meat Try eliminating dairy (has estrogen naturally occurring)
insomnia calcium/magnesium before bed, tryptophan
Dark leafy greens, pumpkin seeds Bedtime routine, see section below, daily exercise, chamomile tea before bed.
Alcohol near bedtime, caffeinated drinks–cut down, out or limit to the beginning of your day
Depression Omega 3, phytoestrogen, B complex, C, magnesium, calcium, zinc Flax seed, good fats, soy, exercise, natural light (or SAD light in winter), exercise alcohol
anxiety calcium Meditation, relaxation, exercise Caffeine, Today’s news. Avoid stressors if possible, also see:
headaches phytoestrogens, magnesium Ginger tea, good fats, veggies listed above, relax
Alcohol, track down any food triggers such as MSG, chocolate, nitrate containing foods (lunch meats, bacon), moldy cheese. Anxiety, insomnia, avoid blood sugar fluctuations, some medications
Joint pain Glucosamine sulfate, chondroitin

Omega 3

flaxseed, good fats Inflammatory foods (processed foods)
fatigue/low energy B complex, especially B12 Flaxseed, seaweed,  Check for anemia, thyroid, relax and exercise, nap for only 20 minutes (ideally while lying on your right side so the blood can “pool” in your liver to fully energize Sugar, refined foods
Low libedo Fermented foods See vaginal dryness below,
Vaginal dryness/tissue atrophy Phytoestrogens, fermented foods Keep hydrated, soy, if you don’t use it, you’ll lose it. Consider locally applied estrogen cream for <1 year.  Also, local application lubricants such as  Vit. E or aloe vera w/ Vit E (possible brands available on Amazon: Aloe Cadabra, Carrageenan), look to for a clearer guide on this topic! Antihistamine, diuretics, be mindful of exhausting yourself and countering it with coffee, alcohol, and sugar…it can decrease lubrication
Yeast infection Plain yogurt, acidophilus probiotic, daily doses 100-600IU of vitamin E for 4-6 weeks 1-2Tbps. Plain yogurt inserted into vagina every 1-2 days
Urinary incontinence Vit D Pelvic and gluteal muscle strengthening, regularly scheduling voiding bladder May be triggered by estrogen supplementation, caffeine
probiotics, water, Vit C 1000mg
Hydrate!  Cranberry juice, pelvic floor exercises, 1 cup plain yogurt 4-5 times a week, cotton underwear, urinating/showering after intercourse.
Consider different birth control, condoms(some)  and diaphragms can be contributing factors. Lubricants (see lubricants link above)
Heavy bleeding
Check with your ob/gyn, B complex, vitamin E, calcium, possibly iron (confirm you have iron deficiency anemia first)
Supportive only eat meat that is hormone free, flax seed, raspberry leaf tea eliminate caffeine, alcohol, spicy foods, no smoking, sugar, processed foods, avoid phytoestrogens, see if going off dairy for a few weeks helps
Skin dryness
Vit C (1000mg) and E (400-800 IU), omega 3 and 6, phytoestrogen, fiber,
Good fats, soy, water, moisturize, flax seeds, zinc if acne, exercise, good sleep
CA prevention, bone health, heart disease
Vit A, E (400-800 IU), K, D, magnesium, potassium, phytoestrogens. Lignans, omega 3, antioxidants (Vit C, E, A, Calcium), selenium, flavonoids (polyphenols)
Soy, good fats, weight-bearing exercise, cruciferous veggies (broccoli etc), brazil nuts, fish, green tea, protein/calcium-rich foods such as tahini, oatmeal, tofu, oats, sardines, salmon, yogurt, nettles, seaweed, amaranth sugar, highly processed foods. caffeine, alcohol, smoking, meat, and salt (calcium is drawn out of bones to neutralize the increased acidity of salt),  carbonated drinks (phosphorus in these drinks competes for calcium absorption), watch salt intake
Brain fog Omega 3, zinc, B complex, selenium, C, E, D, antioxidants
Good fat, brazil nuts, blueberries, exercise
Sugar, processed foods
Weight gain Phytoestrogen, omega 3 Soy, good fat, exercise, check thyroid, Processed foods, sugars, binge eating
Hormone imbalance phytoestrogens, bioflavonoids, lignans Pith of orange and grapefruit, cherries, cranberries, blueberries, whole grains, flax seeds Processed foods, sugar
Digestive health (bloating, gas, acid reflux) Fiber, hydrate, Beans, legumes (add slowly!), cooked foods, Eliminate foods straight out of freezer (including ice), processed foods, don’t’ eat within 3 hours of bed
Eye health Vit k, antioxidant (Vit C, E, A, calcium) Fresh fruit vegetables

The Takeaway:

Eat a diet high in vegetables, fruit, whole grains, nuts (if you aren’t allergic), legumes and stay away from processed, high calorie but poorly nutritious food.  In the table above you will note that I gave specific amounts for some of the vitamins.  That is because these amounts are suggested for a particular symptom.  Otherwise, a good B complex, calcium-magnesium, vitamin D3, and multivitamin should be adequate–if your diet is lacking.  I think it’s worth investing in good quality, all natural supplements rather than synthetic if possible.  



Flax, ground seed:  1-2 tablespoons daily.  Apparently, ground flax seed is higher in lignans than flax oil.  Lignans are a phytoestrogen, so I’d definitely use ground flax seed rather than the oil to get the most benefit for peri-menopausal symptoms. Heating/cooking with the seed will break down the beneficial properties, so you can sprinkle it on foods after they are cooked.


Though some studies have shown that soy isoflavones are safe for women who are at risk for cancer or who have cancer, I am not a fan of soy protein powder or supplements. I equate it to the fact that oranges are good but orange juice is not.  The sugar of the eight oranges in your glass of juice is unmitigated by the pulp/fiber of the eight oranges you would have to eat to get that same sugar load.  In short, soy powder and supplements are too concentrated.  Additionally, soy protein powder and supplements are not recommended as they contain soy isolates (they may mess with hormone levels rather than benefit them). Fermented soy products (miso, tempeh, nato) are best according to Chinese medicine,  as non-fermented soy products (as in tofu, soymilk)  are considered “cold” and can be difficult to digest and to extract the vitamins/minerals.



Brazil nuts are high in selenium which is good for blood vessels, the thyroid (super important to keep happy during the transition through menopause, I’ll get to that later), and are high in protein.  By eating 2-4 a day, you can take care of several things at once!






Regular exercise is key.  There are conflicting reports about the best way to exercise:  some studies conclude that intervals of heart rate raising exercise within a workout is key, others advocate the benefits of simply walking, still others conclude that walking for 10 minutes 3 times a day if you have a sit down job is more beneficial for you than sitting all day and  exercising for 30 minutes before or after work.  What is clear is that movement is key, the body does not like being immobile!


For perimenopausal hot flashes, in particular, you may want to exercise in the morning, not close to bedtime as you’ll raise your body temperature possibly prompting night sweats.  Regular exercise can stop or greatly reduce hot flashes. I cannot emphasize this enough….exercise is the best way to get rid of or greatly reduce the number and intensity of hot flashes.  Weight-bearing exercise is important to keep our bones strong so make sure you incorporate any of the following: walking, jogging, hiking, running, racket sports, weight training, (most if not all) dancing.  Basically, any exercise that forces you to work against gravity.  While swimming and cycling are great aerobic exercises, they aren’t considered to be weight bearing, therefore, don’t benefit bone strength/health as much.

Whatever exercise “routine” you select, make sure you enjoy it.  A teacher of mine once advised that you aren’t human unless your feet walk on dirt for an hour a day….that might not be the answer for everyone, but he had a point:  do what feeds your soul (if you are lucky and persistent enough to find it).  Or make it fun: a dance class at the Y or local tai qi or yoga class.  Make sure your body loves it too.  Even after 25 years post ankle reconstruction, it is still a struggle for me not to run, but forcing myself not to run opened up a new way to appreciate my time in the woods.

Stretching helps joint health and improves balance as we age. You may have seen all the elders in San Francisco park or in the parks of China lined up and doing tai qi.  This is an excellent exercise for elders (and people on their way to becoming elders) because it really opens up the joints increasing flexibility and joint lubrication.  It is considered a “yin” exercise for the “yin” part of our lives.  In other words, tai qi is too yin od an exercise when our yang dominates.  Tai qi is not an appropriate exercise for a healthy child who by nature is the very definition of yang.  They need an exercise that matches all that energy that can be literally exploding out of them.  This is why it is so important for kids to be out running around at recess, after school, and also when….but that’s another blog post.

Sleep hygiene:

This seems to be a hot topic on the internet these days…but it is important.  Bedtime routines, not looking at screens the hour or more before bedtime, not eating too much before bed…but perhaps not being hungry either.  Here is sleep advice with  added perimenopausal symptom insights…..

photo Kathleen Hiatt Cutter

  1. Bedtime routine:  the body operates better with predictability and consistency!
  2. Bed before 11: in Chinese medicine, this is important as it helps your “liver,” your liver is really important to keep happy during perimenopause.  Also, you want to work with, as opposed to against, your internal clock.  
  3. No screens the hour before bedtime: messes with our melatonin and serotonin levels–which help us sleep.
  4. If you have trouble falling asleep or have cramping legs:  calcium and magnesium supplements with warm milk (if you can tolerate/drink dairy–enzyme in milk does help induce sleep-grandma was right).
  5. Don’t eat a large meal before bed as it can make for a restless night.  However, if you find yourself hovering just below wakefulness much of  the night, it might be low blood sugar, try eating a bit of protein before bed—yogurt if you eat dairy, a small piece of toast with avocado or peanut butter, or 7 oz of pumpkin seeds (has tryptophan which makes you sleepy)….you don’t want something hard to digest.  This should keep your blood sugar levels from dipping so much that they trigger a cortisol surge and therefore wakefulness.
  6. Limit all liquid intake after 6 pm, perhaps no more fluids after 4 pm, you might have to experiment: to cut down on nighttime urination….make sure you drink plenty in the day before your cut off time!
  7. Eliminate caffeinated drinks after noon—experiment if you have to have caffeine:  you may find that you are becoming more sensitive to caffeine and need to limit such drinks to earlier in the day.
  8. Eliminate alcohol before bed:  alcohol may make you fall asleep quicker but it will affect your blood sugar levels while you sleep and may wake you up or not allow you to sleep deeply.  Many of my patients are surprised to find that they are affected more and differently by alcohol than they did when they were younger.  In Chinese medicine, alcohol is consider warming….and perimenopausal women tend to be warmer–it’s like throwing on an extra blanket.  Nighttime alcohol may increase night sweats, hot flashes, and headaches as well.
  9. Bedroom temperature should be on the cool side–for a more restful sleep and fewer night sweats/hot flashes.
  10. Have an extra pair of jammies to change into/out of, to ensure comfort and return to sleep after significant night sweats–hopefully, the other things you are doing to help yourself will eliminate this need soon!
  11. If night sweats and hot flashes are a problem:  try soaking your feet only in warm water before bed for 5-10 minutes, it may help draw the heat out of your upper body–also it may make you sleepy!
  12. Herbs:  there are numerous herbal formulas that are excellent for sleep.  Please seek the advice of an herbalist before selecting them by yourself or with the aid of a health food store employee.  Many herbs interact with common pharmaceuticals and they may not be the right herbal combination to help with your sleep disturbance.
  13. I understand you may be tempted to seek relief from a pharmaceutical sleep aid, but I would strongly advise against it. The quality of sleep is not great, they may be habit-forming and they may be dangerous.  One example is  

De-stress measures:


This can take many forms:  time in nature, listening to music, meditating, exercising–whatever forms help you to calm, center, relax and feed your soul.  Our bodies need extra attention and time at this stage in our lives–which can generally be more stressful with the demands of work, children, aging parents, and in the stressful world we live in.  


Balanced life:

Achieving a balanced life may seem like an impossible task for some (or all!)  Even during the most hectic of days, make sure to fit in moments of reflection and gratitude—in the car behind the wheel (but don’t zone out!), as you are standing over the stove, taking a shower.  Try to work in time each day for yourself so you can hear what your “inner voice” has to say.  You may be surprised–or relieved to hear what it has to tell you.  This is where the navel-gazing comes into play.  Our priorities change as we age, it’s important to recognize any changes and while we can’t necessarily immediately make changes we can perhaps make small changes to new goals or freedoms.


Don’t smoke:

We have all heard about the detrimental effects of smoking, suffice it to say it will exacerbate any perimenopausal symptoms you are experiencing.  

Doctor checkup:

If you are symptomatic, it’s a good idea to get the once over by your MD to rule out any other condition that actually may be responsible for your symptoms.  Ask your doctor to do a thyroid work up as well as a complete blood panel.  These blood tests will give you some data points on how your thyroid, blood sugar, cholesterol levels are doing and  if you have any specific vitamin or mineral deficiencies  as well as if any organ system seems “off.”  I will expand upon this in a later post.

Next time:  Step #2 in navigating menopause

Disclaimer.  This is to serve as information only, please seek the care of a medical doctor for symptoms and concerns you may be experiencing.  This is in no way to serve as treatment of any disease or illness.  The following is for information only.