Perimenopause is the transition phase before menopause (typically ages
40-50). Hormone levels fluctuate unpredictably—estrogen can spike then
crash, cycles become irregular. Our plans help you manage symptoms and
support your body through this change.
Weeks 1-2: Hormone Stabilization
Focus: Balance fluctuating estrogen & manage hot flashes
Daily Meal Plan
Breakfast:
• Flaxseed oatmeal with blueberries & walnuts
(phytoestrogens)
• Green tea (cooling, antioxidant-rich)
Snack:
• Edamame or soy yogurt (plant-based estrogen support)
Lunch:
• Salmon salad with leafy greens, chickpeas, olive oil
• Side
of fermented vegetables (gut health)
Snack:
• Apple with almond butter & cinnamon (blood sugar stability)
Dinner:
• Tofu or chicken stir-fry with broccoli, bell peppers
•
Brown rice or quinoa
Key Foods: Phytoestrogens (flax, soy), omega-3s,
fiber-rich foods. AVOID: Spicy foods, caffeine, alcohol (trigger hot
flashes)
Weekly Workout
Plan
Mon/Wed/Fri:
30-min moderate strength training (focus on bone density: squats,
lunges, rows)
Tue/Thu:
25-min low-impact cardio (swimming, cycling, brisk walking)
Sat:
40-min yoga for stress relief & flexibility
Sun:
Rest or gentle stretching + meditation (10 min)
Goal: Build bone density, manage weight changes,
reduce stress to minimize hot flash triggers
Weeks 3-4: Sleep & Mood Support
Focus: Improve sleep quality & stabilize mood swings
Daily Meal Plan
Breakfast:
• Scrambled eggs with spinach & mushrooms (vitamin D, B12)
•
Whole grain toast with avocado
Snack:
• Tart cherry juice (melatonin support) or handful of almonds
Lunch:
• Turkey or lentil soup with kale, carrots, celery
• Side of
whole grain crackers
Snack:
• Dark chocolate (70%+) with banana (serotonin boost)
Dinner:
• Baked cod with roasted sweet potato & asparagus
•
Chamomile tea 1 hour before bed
Key Nutrients: Magnesium (sleep), B-vitamins
(mood), tryptophan (serotonin). Evening routine: no screens 1 hour
before bed
Weekly Workout
Plan
Mon/Wed/Fri:
30-min strength + balance exercises (prevent falls, bone health)
Tue/Thu:
20-min morning walk (sunlight exposure for circadian rhythm)
Sat:
45-min restorative yoga or tai chi (stress reduction)
Sun:
Gentle evening walk + 15-min meditation before bed
Goal: Support healthy sleep patterns, reduce
nighttime waking, stabilize mood through endorphin release
Sample Perimenopause Protocol
Patient Profile Example:
• Age 46, cycles becoming irregular (25-40 days)
• Hot flashes
8-10x daily
• Night sweats disrupting sleep 4-5x/week
• Mood
swings, increased anxiety
• Weight gain of 12 lbs in past year
•
Lab results: FSH 35 mIU/mL (elevated), estradiol fluctuating 20-150
pg/mL
Recommended Supplement Protocol
Black Cohosh Extract
40mg daily
Why: Clinically proven to reduce hot flash
frequency by 26-50% within 8 weeks. Acts on neurotransmitters to
regulate body temperature.
When: Take 20mg twice daily (morning and evening)
with meals.
Expected outcome: Significant reduction in hot
flashes within 4-8 weeks. Monitor liver enzymes if taking
long-term (though rare, can affect liver).
Magnesium Glycinate
400mg nightly
Why: 75% of perimenopausal women are magnesium
deficient. Improves sleep quality, reduces anxiety, helps with
muscle tension and night sweats.
When: Take 400mg 1 hour before bed. Glycinate
form is highly absorbable and won't cause digestive issues.
Expected outcome: Better sleep within 1-2 weeks,
reduced nighttime waking, calmer mood during the day.
Vitamin D3 + K2
5000 IU D3 + 100mcg K2
Why: Bone density declines rapidly during
perimenopause. Vitamin D3 supports calcium absorption, K2 directs
calcium to bones (not arteries). Together they prevent
osteoporosis.
When: Take with breakfast (fat-soluble vitamins
absorb better with food containing healthy fats).
Expected outcome: Vitamin D levels reach optimal
40-60 ng/mL within 8-12 weeks. Improved mood, immune function,
bone health.
Omega-3 Fish Oil (EPA/DHA)
2000mg daily
Why: Reduces inflammation, supports
cardiovascular health (risk increases during perimenopause),
improves mood, and may reduce hot flash intensity.
When: Take with largest meal of the day to
minimize fishy aftertaste. Look for molecularly distilled,
third-party tested brands.
Expected outcome: Reduced joint pain, better mood
stability, cardiovascular protection. Effects noticeable within
4-6 weeks.
Adaptogenic Blend (Ashwagandha + Rhodiola)
600mg daily
Why: Adaptogens help regulate cortisol (stress
hormone). High cortisol worsens hot flashes, disrupts sleep, and
causes weight gain. Ashwagandha specifically shown to reduce
anxiety by 40%.
When: Take 300mg in morning, 300mg in afternoon.
Avoid evening (some find it energizing).
Expected outcome: Better stress resilience,
improved energy without jitteriness, reduced anxiety within 2-4
weeks.
Lifestyle Modifications
Hot Flash Triggers to Avoid:
- • Caffeine after 12pm
- • Alcohol (especially red wine)
- • Spicy foods
- • Hot beverages
- • Tight clothing, synthetic fabrics
Sleep Hygiene Protocol:
- • Keep bedroom 65-68°F (cool)
- • Blackout curtains or sleep mask
- • No screens 1 hour before bed
- • Bedtime routine: warm bath, magnesium, chamomile tea
- • Wear moisture-wicking pajamas
Retest & Adjust Timeline
Week 4: Check-in on hot flash frequency, sleep
quality, mood. Adjust doses if needed.
Week 8: Full symptom reassessment. Most women see
50%+ improvement by this point.
Week 12: Retest labs (FSH, estradiol, vitamin D,
thyroid). Consider HRT consultation if symptoms persist despite
protocol adherence.
Ongoing: Quarterly check-ins to adjust protocol as
hormone levels continue to change during perimenopause transition.
Perimenopause Protocol Summary
-
Cycle adaptations: Plans adjust based on whether
you're still having periods or they've become irregular
-
Hot flash management: Cooling foods, avoid triggers,
strategic exercise timing
-
Bone health focus: Weight-bearing exercises, calcium
& vitamin D-rich foods
-
Weight management: Metabolism slows—emphasize
protein, strength training, portion control
Menopause begins after 12 consecutive months without a period (average age
51). Estrogen and progesterone levels are permanently low. Our plans focus
on maintaining muscle mass, bone density, metabolic health, and quality of
life.
Weeks 1-2: Metabolic Support
Focus: Maintain healthy weight & boost metabolism
Daily Meal Plan
Breakfast:
• Protein smoothie (whey/plant protein, berries, spinach, flax)
•
Boiled eggs or Greek yogurt on the side
Snack:
• Protein bar or cottage cheese with cucumber
Lunch:
• Grilled chicken or tempeh with quinoa & roasted
vegetables
• Large mixed green salad with olive oil
Snack:
• Handful of walnuts or pumpkin seeds
Dinner:
• Baked salmon with Brussels sprouts & sweet potato
•
Finish eating 3 hours before bed
Macros: High protein (30-35%), moderate healthy
fats (30%), lower carbs (35-40%). Prioritize protein at every meal
to preserve muscle mass.
Weekly Workout Plan
Mon/Wed/Fri:
40-min strength training (full body, heavier weights, 3-4 sets,
8-12 reps)
Tue/Thu:
30-min HIIT or interval training (metabolism boost)
Sat:
45-min power walk or hike (steady-state cardio)
Sun:
Active recovery: yoga or stretching (30 min)
Goal: Build & maintain muscle mass to keep
metabolism active. Muscle burns more calories at rest than fat.
Weeks 3-4: Bone & Joint Health
Focus: Prevent osteoporosis & maintain mobility
Daily Meal Plan
Breakfast:
• Fortified oatmeal with chia seeds, almonds, berries
•
Vitamin D-fortified orange juice or supplement
Snack:
• Yogurt (calcium-rich) or bone broth
Lunch:
• Sardines or canned salmon (with bones) over greens
• Side
of white beans (calcium, magnesium)
Snack:
• Cheese stick or collagen peptides in water
Dinner:
• Grass-fed beef or tofu with kale, broccoli (vitamin K)
•
Roasted sweet potato with sesame seeds
Key Nutrients: Calcium (1200mg/day), Vitamin D
(800-1000 IU), Vitamin K, Magnesium, Collagen for joint support
Weekly Workout Plan
Mon/Wed/Fri:
40-min weight-bearing exercises (squats, lunges, deadlifts,
step-ups)
Tue/Thu:
30-min low-impact cardio (elliptical, swimming) for joint-friendly
movement
Sat:
45-min balance & stability training (single-leg exercises,
bosu ball)
Sun:
Gentle yoga focusing on flexibility & joint mobility
Goal: Weight-bearing exercises stimulate bone
formation. Balance training prevents falls (major cause of fractures
post-menopause).
Heart Health Priority
Estrogen loss increases cardiovascular risk. Focus on:
- • Omega-3 rich fish (3x per week)
- • Limited saturated fats, trans fats
- • 150+ min moderate cardio weekly
- • Monitor blood pressure & cholesterol
Cognitive Support
Support brain health during hormone changes:
- • Berries, leafy greens (antioxidants)
- • Fatty fish, walnuts (brain health)
- • Regular exercise (blood flow to brain)
- • Quality sleep (7-9 hours)
Sample Menopause Protocol
Patient Profile Example:
• Age 53, 18 months post-menopause
• Moderate hot flashes persist
(6-8x daily)
• Weight gain of 18 lbs since menopause
• Low
energy, brain fog, decreased libido
• Bone density scan: T-score
-1.8 (osteopenia)
• Lab results: Estradiol <20 pg/mL, FSH 78 mIU/mL
(menopausal range)
Hormone Replacement Therapy (HRT)
Option
Based on this profile, HRT may be appropriate if started within 10
years of menopause and no contraindications (history of breast cancer,
blood clots, stroke).
Typical HRT Protocol:
• Estradiol patch (0.05mg twice weekly) OR daily
gel
• Progesterone (200mg oral, nightly) –
protects uterine lining
• May add low-dose testosterone if
libido severely impacted
*HRT dramatically improves hot flashes, sleep, mood, bone density,
and cardiovascular health when used appropriately. Discuss with
provider via $49 telehealth consult.*
Supplement Protocol (Non-HRT or Adjunct)
Calcium Citrate + Vitamin D3 + K2
1200mg Ca / 2000 IU D3 / 180mcg K2
Why: CRITICAL for bone health. Calcium citrate is
better absorbed than carbonate (especially for women over 50). D3
enables absorption, K2 directs calcium to bones, not arteries.
When: Split calcium into 600mg doses (morning &
evening with meals) for better absorption. Take D3+K2 with
breakfast.
Expected outcome: Slows bone density loss. With
T-score -1.8, this is NON-NEGOTIABLE to prevent progression to
osteoporosis.
Collagen Peptides
10-20g daily
Why: Supports bone matrix (not just calcium!),
improves skin elasticity (thinning skin common in menopause),
reduces joint pain, supports gut lining.
When: Mix 1-2 scoops in morning coffee, smoothie,
or water. Tasteless and dissolves completely.
Expected outcome: Joint pain improvement within
4-8 weeks. Skin hydration/elasticity improves in 8-12 weeks.
Creatine Monohydrate
5g daily
Why: GAME-CHANGER for postmenopausal women.
Preserves muscle mass, improves strength gains, supports bone
density, enhances cognitive function (brain fog!), and may reduce
hot flash severity.
When: Take 5g daily (timing doesn't matter). Mix
in water or post-workout shake. May cause slight water retention
initially (normal).
Expected outcome: Increased strength in 2-4
weeks. Improved energy and cognition within 4-8 weeks.
CoQ10 (Ubiquinol form)
200mg daily
Why: Supports mitochondrial function (cellular
energy production declines with age). Improves energy, supports
heart health (cardiovascular risk increases post-menopause),
powerful antioxidant.
When: Take with breakfast or lunch (fat-soluble,
needs food). Ubiquinol form is 8x more bioavailable than
ubiquinone.
Expected outcome: Increased energy and reduced
fatigue within 4-6 weeks. Cardiovascular protection (long-term
benefit).
Sage Extract (for hot flashes)
300mg daily
Why: Clinical studies show sage reduces hot flash
frequency by 50% and severity by 46% within 8 weeks. Works on
hypothalamus temperature regulation.
When: Take once daily in the morning.
Standardized extract works better than tea.
Expected outcome: Noticeable reduction in hot
flashes within 4 weeks, peak benefit at 8 weeks.
Metabolic & Muscle Preservation Strategy
Protein Target:
- • 1.2-1.6g protein per kg body weight
- • 25-30g protein per meal minimum
- • Prioritize leucine-rich foods (eggs, chicken, dairy)
- • Protein shake within 30 min post-workout
Strength Training Non-Negotiables:
- • 3x per week minimum (full body or split)
- • Progressive overload: gradually increase weight
- • Compound movements: squats, deadlifts, rows, presses
- • 8-12 rep range for muscle maintenance
Monitoring & Adjustment Timeline
Month 1: Symptom tracking (hot flash frequency,
energy, sleep quality). Body composition scan (baseline
muscle/fat%).
Month 3: Retest vitamin D levels, comprehensive
metabolic panel. DEXA scan for bone density if not done recently.
Month 6: Full reassessment. Measure progress:
weight, body comp, bone density trajectory, symptom severity. Adjust
protocol based on results.
Annual: Lipid panel, blood pressure, fasting
glucose/insulin, bone density scan, mammogram. Adjust HRT dose if
applicable.
Menopause Protocol Summary
-
Muscle preservation: High protein intake +
consistent strength training is NON-NEGOTIABLE
-
Bone density: Weight-bearing exercise + 1200mg
calcium daily prevents osteoporosis
-
Metabolic adaptation: Strength training maintains
metabolism despite lower estrogen
-
Quality of life: Regular exercise reduces severity
of symptoms (hot flashes, mood, sleep)
PCOS (Polycystic Ovary Syndrome) and irregular cycles are often driven by
insulin resistance, inflammation, and hormonal imbalances. Our plans focus
on blood sugar stabilization, reducing inflammation, and restoring hormonal
balance naturally.
Weeks 1-2: Blood Sugar Control
Focus: Reduce insulin resistance & stabilize energy
Daily Meal Plan
Breakfast:
• Veggie omelet with avocado (high protein, healthy fats)
•
No juice or sweetened beverages
Snack:
• Celery sticks with almond butter (low-glycemic)
Lunch:
• Grilled chicken or chickpeas with large salad
• Small
portion of quinoa or sweet potato (complex carbs only)
Snack:
• Hard-boiled eggs or Greek yogurt (unsweetened)
Dinner:
• Salmon or grass-fed beef with roasted vegetables
•
Cauliflower rice instead of white rice
Critical Rules: NO refined carbs, white bread,
pasta, sugary foods. Pair carbs with protein/fat. Eat every 3-4
hours to stabilize blood sugar.
Weekly Workout
Plan
Mon/Wed/Fri:
40-min strength training (builds insulin-sensitive muscle tissue)
Tue/Thu:
30-min post-meal walks (lowers post-meal glucose spikes)
Sat:
45-min moderate cardio (cycling, swimming, hiking)
Sun:
Gentle yoga + stress management (cortisol reduction)
Goal: Strength training improves insulin
sensitivity by 20-40%. Post-meal walks lower glucose by 15-20%.
Weeks 3-4: Reduce Inflammation
Focus: Lower chronic inflammation & support ovulation
Daily Meal Plan
Breakfast:
• Berry smoothie with protein powder, flaxseed, turmeric
•
Handful of walnuts (omega-3s)
Snack:
• Fresh berries with hemp seeds (antioxidants)
Lunch:
• Wild salmon with kale salad, avocado, olive oil
• Side of
roasted beets (liver support)
Snack:
• Golden milk (turmeric, ginger, almond milk)
Dinner:
• Chicken or tempeh with cruciferous vegetables (broccoli,
cauliflower)
• Sauerkraut or kimchi for gut health
Anti-Inflammatory Foods: Fatty fish, berries, leafy
greens, turmeric, ginger, green tea. AVOID: Dairy (inflammatory for
many with PCOS), processed foods
Weekly Workout
Plan
Mon/Wed/Fri:
40-min full-body resistance training (progressive overload)
Tue/Thu:
25-min HIIT (short bursts improve insulin sensitivity)
Sat:
45-min steady-state cardio (zone 2 heart rate)
Sun:
Restorative yoga + meditation (manage cortisol & stress)
Goal: Balance high-intensity with recovery.
Overtraining raises cortisol, worsening PCOS symptoms.
Patient Profile Example:
• Age 29, cycles 35-60 days apart (irregular)
• Acne, hirsutism
(excess hair growth on face/chest)
• Weight gain of 25 lbs over 2
years, difficulty losing weight
• Fatigue, sugar cravings, mood
swings
• Lab results: Fasting insulin 18 μIU/mL (elevated, insulin
resistance), Testosterone 75 ng/dL (high), LH/FSH ratio 3:1 (indicative
of PCOS)
Core
PCOS Supplement Protocol
Myo-Inositol + D-Chiro-Inositol (40:1 ratio)
4g daily
Why: THE #1 supplement for PCOS. Improves insulin
sensitivity by 30-40%, restores ovulation in 60-70% of women,
reduces testosterone levels, improves egg quality. This is as
close to a "magic pill" as PCOS has.
When: Take 2g twice daily (morning & evening)
with meals. 40:1 ratio (myo:d-chiro) is optimal—most research
supports this exact ratio.
Expected outcome: Cycle regularity improves
within 3 months. Insulin levels drop within 8-12 weeks. Many women
ovulate for the first time in years.
Berberine
1500mg daily
Why: As effective as Metformin for insulin
resistance but natural. Lowers fasting insulin, reduces
testosterone, improves lipid profiles, supports weight loss.
Activates AMPK pathway (cellular energy regulation).
When: Take 500mg three times daily with meals.
Start with 500mg/day for first week to avoid GI upset, then
increase gradually.
Expected outcome: Fasting insulin drops by 20-30%
within 12 weeks. Weight loss of 5-10 lbs in first 3 months (when
combined with diet/exercise).
N-Acetyl Cysteine (NAC)
1800mg daily
Why: Powerful antioxidant that improves insulin
sensitivity, restores ovulation, reduces inflammation. Studies
show 600mg 3x/day improves menstrual regularity and pregnancy
rates in PCOS women.
When: Take 600mg three times daily with meals.
Works synergistically with inositol.
Expected outcome: Improved cycle regularity
within 2-3 months. Reduced oxidative stress markers.
Omega-3 Fish Oil (EPA/DHA)
2000-3000mg daily
Why: Reduces chronic low-grade inflammation
driving PCOS. Lowers triglycerides, improves insulin sensitivity,
reduces androgen levels. Anti-inflammatory effects are critical
for PCOS management.
When: Take with largest meal of the day. Look for
brands with high EPA content (>1000mg EPA per serving).
Expected outcome: Reduced inflammation markers
(hs-CRP) within 8 weeks. Improved lipid profile, less joint
pain/inflammation.
Vitamin D3
5000 IU daily
Why: 85% of PCOS women are vitamin D deficient.
Deficiency worsens insulin resistance, disrupts ovulation,
increases inflammation. Optimizing D3 is foundational.
When: Take with breakfast (fat-soluble). Aim for
blood level of 40-60 ng/mL.
Expected outcome: Improved insulin sensitivity,
better mood, enhanced immune function within 8-12 weeks.
Spearmint Tea
2 cups daily
Why: Clinically proven to reduce free
testosterone and hirsutism (unwanted hair growth). Works by
blocking androgen receptors. Natural anti-androgen.
When: Steep 1 tsp dried spearmint leaves in hot
water for 5-10 minutes. Drink 1 cup morning, 1 cup evening.
Expected outcome: Reduced hirsutism/acne within 3
months. Testosterone levels decrease by 20-30%.
Diet & Lifestyle Non-Negotiables
Blood Sugar Management:
- • ELIMINATE refined carbs, white bread, pasta, sugar
- • Never eat carbs alone—pair with protein & healthy fat
- • Eat every 3-4 hours to prevent crashes
- • 15-20 min walk after meals (lowers glucose by 15-20%)
-
• Consider CGM (continuous glucose monitor) to see patterns
Strength Training Priority:
- • 3-4x per week (builds insulin-sensitive muscle)
- • Progressive overload: increase weight each week
- • Full-body compound movements (squats, deadlifts, rows)
- • Muscle is the #1 site of glucose disposal
- • More muscle = better insulin sensitivity
Foods to Prioritize:
- • Fatty fish (salmon, sardines, mackerel)
- • Leafy greens, cruciferous vegetables
- • Berries (low-glycemic antioxidants)
- • Nuts, seeds, avocado (healthy fats)
- • Fermented foods (sauerkraut, kimchi for gut health)
Foods to AVOID:
- • Refined carbs, white bread, pasta, pastries
- • Sugary drinks, juice, sweetened beverages
-
• Dairy (inflammatory for many PCOS women—trial elimination)
-
• Alcohol (worsens insulin resistance, hormone metabolism)
- • Processed foods with seed oils (inflammatory)
Success Metrics & Testing Timeline
Month 1: Daily symptom tracking (energy, cravings,
mood). Track cycle length. Weigh weekly (aim for 1-2 lbs/week loss
if overweight).
Month 3: Retest labs: fasting insulin, fasting
glucose, HbA1c, testosterone, DHEA-S, vitamin D. Most women see
30-50% improvement in insulin by this point.
Month 6: Full reassessment. By 6 months, 60-80% of
women restore regular ovulation with this protocol. Consider
ovulation tracking (OPKs, BBT, cervical mucus).
Success markers: Cycle regularity (28-35 days),
reduced acne/hirsutism, stable energy (no crashes), weight loss of
5-10%, fasting insulin <10 μIU/mL, testosterone back in normal
range.
Restoring Regular Cycles
Nutrition Keys
-
Inositol: 2g daily (improves egg quality,
insulin sensitivity)
-
Omega-3s: 2000mg daily (reduces inflammation,
supports hormone production)
-
Magnesium: 300-400mg daily (improves insulin
sensitivity, reduces anxiety)
-
Vitamin D: Optimize to 40-60 ng/mL (critical for
ovulation)
-
Spearmint tea: 2 cups daily (lowers androgens,
reduces hirsutism)
Lifestyle Factors
-
Sleep: 7-9 hours (poor sleep worsens insulin
resistance)
-
Stress management: High cortisol disrupts
ovulation
-
Weight loss: Even 5-10% body weight loss can
restore cycles
-
Avoid endocrine disruptors: Plastics, BPA,
parabens
-
Track ovulation: BBT, OPKs, cervical mucus
monitoring
PCOS/Irregular Cycle Protocol Summary
-
Blood sugar is key: Low-glycemic diet + strength
training reverses insulin resistance in 8-12 weeks
-
Anti-inflammatory focus: Omega-3s, berries, leafy
greens reduce chronic inflammation driving PCOS
-
Exercise balance: Mix strength + HIIT + recovery.
Overtraining worsens hormones.
-
Cycle restoration: 60-80% of women with PCOS restore
regular ovulation with diet & exercise alone
-
Timeline: Expect improvements in 3-6 months.
Consistency is everything.