Perimenopause: A Full-Body System Update
Written By: Kelly McCarthy
Perimenopause is a several-year period of major hormonal transition much akin to puberty, and culminating in menopause (the cessation of the menstrual cycle i n a mature body).
Estrogen’s Decline
During perimenopause, the body’s estrogen stores decline significantly. Estrogen’s functions on the body are far reaching, so the transition from having a period to not having a period encompasses commonly reported symptoms like hot flashes, insomnia, mood changes, genital tissue changes, and cognitive changes.
It tends to be a rollercoaster of mood and bodily transition that takes, on average, 8 years. Cognitive changes due to estrogen decline start for most people in their late 30s, with the majority of other symptoms felt most strongly in their 40s.
Beyond its role in reproduction, estrogen plays a role in dozens of bodily processes that many of us have never considered. Estrogen helps you poop. It has a protective action against high cholesterol. It impacts how the body makes glucose for energy.
Estrogen affects blood pressure and sodium retention. Estrogen mediates serotonin, dopamine, and GABA, all neurotransmitters that support mood. Changes in estrogen can impact digestion, cardiovascular health, blood sugar, cognition, mood, and more.
Stress & the Adrenal Glands
The adrenal glands, where our stress hormones are produced and stored, play a huge role in perimenopause. Before perimenopause, the ovaries produced 90-95% of estrogen, but once ovarian estrogen production declines in perimenopause, the adrenals and fat cells become the main lifetime producers of estrogen.
Our stress response pathways are impacted in perimenopause by the estrogen decline, as well as a decline in other key hormones like progesterone and allopregnanolone. These hormones help to regulate mood on their own, and positively impact the stress response cycle before perimenopause. As they decrease, we are less able to regulate the stress cycle, and less able to mediate neurotransmitters that make us feel calm and centered.
Many perimenopause symptoms are worse with stress, so we feel additionally challenged – stressed, worse symptoms because of stress, and our internal mechanisms for dealing with stress are diminished. What a set up!
The good news is that eventually these hormones and neurotransmitters come back to an equilibrium after perimenopause. This is a big reason for anxiety, depression, cognitive changes, and mood swings.
Herbal Support for Perimenopause
While there are many specific herbal remedies for specific perimenopausal symptoms, the most important thing you can do is support your nervous system and stress response cycle, because almost all perimenopause symptoms increase with increased stress.
Nervines are a class of herbs that tend to have a calming, grounding effect on the nervous system. Some of my favorite nervines that can offer relief during perimenopause are:
Tulsi
Lemon balm
Chamomile
Skullcap
Linden
Rose
Lavender
You might also consider Motherwort and Blue vervain as nervines for frustration, anger, and irritability.
Herbs are most effective when taken on a regular basis. Consistency is key! Find what works best for you –teas, tinctures, capsules, powders – so that you’re able to take the herbs more days than not.
Tea: try 4 tbsp of dried herbs to 32oz of just boiled water. Cover and steep 1 hour.
Tinctures can be nice if the herbs have an unpleasant taste or you want higher doses. Best used daily, 2mL (½ tsp), 3x / day is a good place to start. For acute symptoms, use 2mL (½ tsp) every 15 mins for 1 hour, then again as needed up to 12x / day.
Speaking with a skilled herbalist is a great way to get recommendations specific to your symptoms and integrate an herbal formula that will address your needs.
Want to Learn More?
Join us in October for a LIVE online class hosted by Kelly McCarthy to explore this topic!
October 3, 2026 - What to Expect with Perimenopause
10:00-11:30am PST / 1:00-2:30pm EST
Symptoms and the changes that come with of perimenopause can be a rollercoaster of unexpected twists and turns for many people. This 1.5 hour class will help prepare participants with practical tools, herbs, and dietary suggestions to support common side effects to meet this transition with the care it deserves. Registration closes on October 1.
About the Author: Kelly is a community herbalist, RH(AHG) and somatic practitioner. Since 2014, she has helped hundreds of clients improve their relationship with their body and health. She especially loves working with queers navigating mental health challenges. When not fawning over plants, she's nerding out about the nervous system, eating fancy cheese, or playing the drums. If you want to check out her teaching style, you can find some free classes on her website, www.atticapothecary.com.