Frequently Asked Questions

Perimenopause and menopause are natural stages of reproductive aging, but they are not the same.

Perimenopause is the transition leading up to menopause. During this time, hormone levels fluctuate, menstrual cycles may become irregular, and symptoms such as hot flashes, night sweats, sleep disturbances, and vaginal dryness may develop.

Menopause is reached after 12 consecutive months without a menstrual period, when no other medical or physiological cause explains the absence of menstruation. Natural menopause typically occurs between ages 45 and 55.

Every woman's experience is different. Some experience minimal symptoms, while others may benefit from medical evaluation and treatment.

Explore the trusted educational resources below to better understand these changes and prepare for a conversation with your healthcare provider.

Perimenopause (NIH)

Perimenopause (Cleveland Clinic)

Perimenopause (Mayo Clinic)

Menopause (NIH)

Menopause (Cleveland Clinic)

Perimenopause and menopause affect every woman differently. Some experience mild symptoms, while others may notice hot flashes, night sweats, sleep disturbances, mood changes, vaginal dryness, or changes in their menstrual cycles.

The good news is that effective treatment options are available. Depending on your symptoms, medical history, and personal preferences, management may include:

• Lifestyle adjustments: Regular physical activity, healthy sleep habits, stress management, and identifying personal hot flash triggers.
• Menopausal hormone therapy (MHT): An effective treatment for bothersome hot flashes and night sweats in appropriately selected patients.
• Nonhormonal prescription treatments: Certain medications may help manage hot flashes when hormone therapy is not preferred or appropriate.
• Vaginal treatments: Vaginal moisturizers, lubricants, and prescription therapies can help relieve vaginal dryness and discomfort.

Changes in menstrual bleeding are common during perimenopause, but heavy, prolonged, or otherwise unusual bleeding should be evaluated. Any vaginal bleeding after menopause also requires medical evaluation.

You do not have to manage bothersome symptoms alone. A healthcare visit can help identify your concerns, review available treatments, and develop a personalized plan.

Explore the ACOG resources below to learn more about managing symptoms and preparing for a conversation with your healthcare provider.

An Ob-Gyn’s Top Tips for Managing Hot Flashes (ACOG)

What can I do to help with hot flashes? (ACOG)? 

Mood Changes During Perimenopause Are Real. Here’s What to Know. (ACOG)

Perimenopausal Bleeding and Bleeding After Menopause (ACOG)

Perimenopause brings many changes, including hot flashes, sleep disturbances, mood changes, and fluctuations in energy. Because every woman's experience is different, finding relief often involves a combination of healthy daily habits, supportive strategies, and individualized medical care.

Lifestyle changes can support your overall health and well-being during this transition. 

However, not all natural remedies or dietary supplements have been shown to effectively treat menopause symptoms, and some may cause side effects or interact with medications.

This guide explores practical lifestyle strategies, commonly used supplements, and mind-body approaches while explaining what current research tells us about their potential benefits and limitations.

Multivitamins During Perimenopause & Menopause

A daily multivitamin may help fill nutritional gaps when dietary intake is insufficient. However, not everyone needs a multivitamin, and these supplements have not been proven to treat hot flashes or other menopause symptoms.

Individual nutritional needs vary based on diet, age, medical history, and medications. Discuss supplementation with your healthcare provider to determine whether it is appropriate for you.

Calcium and vitamin D are important for maintaining bone health, especially as declining estrogen levels increase the risk of bone loss.

Recommended Daily Calcium Intake:

• Women ages 19–50: 1,000 mg daily.
• Women ages 51 and older: 1,200 mg daily.

These amounts include calcium from both food and supplements. Good dietary sources include dairy products, fortified plant-based milk, calcium-set tofu, and leafy green vegetables.

Helpful Tip: Aim to meet your calcium needs through food first. If your dietary intake is insufficient, a supplement may help fill the gap. Discuss supplementation with your healthcare provider, particularly if you have a history of kidney stones or other medical conditions.

Vitamin Options: 

- One A Day Women's Menopause Multivitamin, Menopause Support

- Citracal Slow Release- Calcium 1200 mg with Vitamin D3

Healthy daily habits can support your physical and emotional well-being during perimenopause and menopause. Although lifestyle changes may not eliminate every symptom, they can improve overall health, energy, sleep, and long-term wellness.

A balanced diet can help support cardiovascular health, bone health, and healthy aging.

• Fruits & Vegetables: Choose a variety of colorful produce for fiber, vitamins, minerals, and antioxidants.
• Whole Grains: Include oatmeal, brown rice, quinoa, and whole-grain breads to support digestive and metabolic health.
• Lean Proteins: Include fish, poultry, eggs, beans, lentils, tofu, and other protein-rich foods to help maintain muscle mass.
• Healthy Fats: Choose foods such as olive oil, avocados, nuts, and seeds.
• Calcium & Vitamin D: Include foods that support bone health, such as dairy products, fortified alternatives, and appropriate dietary sources of vitamin D.

Helpful Tip: A Mediterranean-style eating pattern is a practical option for supporting cardiovascular and metabolic health during midlife.

Some plant foods contain naturally occurring compounds called phytoestrogens, which have weak estrogen-like activity.

Examples include:

• Soy Foods: Tofu, tempeh, edamame, and soy milk.
• Flaxseeds: Ground flaxseeds can provide fiber and healthy fats.
• Legumes: Beans, chickpeas, and lentils provide plant protein and fiber.

Although some studies have explored phytoestrogens for menopause symptoms, the evidence for reducing hot flashes and night sweats remains inconsistent.

Whole plant foods can still be part of a healthy diet, even when they do not directly relieve menopause symptoms.

Regular physical activity is one of the most beneficial habits for maintaining health during menopause.

• Aim for at least 150 minutes of moderate-intensity aerobic activity each week, such as brisk walking, cycling, or swimming.
• Include muscle-strengthening activities at least twice weekly to help maintain muscle mass and strength.
• Incorporate balance and flexibility exercises, such as yoga or tai chi.
• Choose activities you enjoy and gradually increase your activity level when appropriate.

Helpful Tip: Weight-bearing and resistance exercises are especially valuable for maintaining bone and muscle health as estrogen levels decline.

Exercise supports overall health and may improve mood and sleep, although it has not consistently been shown to reduce hot flashes directly.

Some individuals notice that certain situations or foods seem to trigger hot flashes.

Commonly reported triggers include:

• Hot beverages
• Spicy foods
• Alcohol
• Caffeine
• Warm environments
• Emotional stress

Helpful Tip: Consider keeping a symptom journal to identify patterns. Not everyone has the same triggers, and avoiding specific foods or drinks is unnecessary unless you notice a personal connection.

Sleep disturbances are common during perimenopause and menopause, especially when night sweats are present.

• Maintain consistent bedtime and wake-up times.
• Keep your bedroom cool, dark, and comfortable.
• Limit caffeine later in the day if it affects your sleep.
• Reduce screen exposure before bedtime.
• Establish a relaxing nighttime routine.

If sleep problems persist, discuss them with your healthcare provider. Cognitive behavioral therapy for insomnia (CBT-I) is an evidence-based treatment for chronic insomnia.

Hormonal changes, sleep disruption, and life stressors can affect mood during the menopause transition.

Helpful strategies include:

• Staying socially connected with friends and family.
• Practicing mindfulness, meditation, or relaxation exercises.
• Engaging in enjoyable hobbies and regular physical activity.
• Seeking professional support when anxiety, depression, or persistent mood changes interfere with daily life.

Helpful Tip: Menopause-focused cognitive behavioral therapy (CBT) can help some individuals manage the impact of hot flashes, sleep difficulties, and related distress.

• Stay Hydrated: Drink water regularly throughout the day and adjust your intake based on activity, climate, and individual health needs.
• Avoid Smoking: Smoking increases cardiovascular and other health risks and is associated with earlier menopause.
• Limit Alcohol: Reducing alcohol consumption supports overall health and may help individuals who identify alcohol as a symptom trigger.
• Keep Up With Preventive Care: Continue recommended blood pressure, cholesterol, diabetes, cancer screening, and bone health evaluations based on your age and individual risk factors.

Remember: Lifestyle strategies are an important part of healthy aging, but they are not a substitute for effective medical treatment when menopause symptoms are bothersome. Hormonal and nonhormonal treatment options are available and should be discussed with your healthcare provider.

Many women explore herbal supplements and natural remedies to help manage symptoms during perimenopause and menopause. Although some products are widely marketed for hot flashes, sleep disturbances, mood changes, and other symptoms, scientific evidence supporting their effectiveness is often limited or inconsistent.

Important: Dietary supplements are not evaluated or approved by the FDA for effectiveness before they are marketed. Some may interact with medications or cause adverse effects. Always discuss supplements with your healthcare provider before starting them.

Black cohosh is an herbal supplement commonly marketed for hot flashes, night sweats, and other menopause-related symptoms.

What Does the Research Say?

Some studies suggest black cohosh preparations may provide modest relief from certain menopause symptoms, but results are inconsistent. The Menopause Society does not recommend herbal supplements, including black cohosh, as evidence-based treatments for vasomotor symptoms.

Safety Considerations:

• Rare cases of liver injury have been reported in people taking products labeled as black cohosh, although a direct causal relationship has not been established.
• Product quality and ingredients may vary.
• Individuals with liver disease or a history of hormone-sensitive cancer should consult their healthcare provider before considering use.

Product Reference: 

NOW Supplements, Black Cohosh Root

Red clover contains naturally occurring compounds called isoflavones, which have weak estrogen-like activity.

What Does the Research Say?

Red clover has been studied for hot flashes and other menopause symptoms. However, research findings are inconsistent, and there is insufficient reliable evidence to recommend it as an effective treatment.

Claims that red clover improves cardiovascular health or prevents bone loss are not well established.

Safety Considerations:

• Red clover may have potential interactions with medications, including anticoagulants.
• Long-term safety information is limited.
• Individuals with hormone-sensitive medical conditions should seek medical guidance before using concentrated isoflavone supplements.

Magnesium is an essential mineral involved in muscle function, nerve signaling, and bone health.

What Does the Research Say?

Adequate magnesium intake supports overall health. However, there is insufficient evidence that magnesium supplements specifically treat hot flashes, menopause-related anxiety, or sleep disturbances in individuals without a deficiency.

Recommended Daily Magnesium Intake:

• Women ages 31 and older: 320 mg daily from food and supplements combined.

Good dietary sources include nuts, seeds, legumes, whole grains, and leafy green vegetables.

Safety Considerations:

• Supplemental magnesium may cause diarrhea, nausea, or abdominal cramping.
• Adults generally should not exceed 350 mg daily of magnesium from supplements and medications unless directed by a healthcare professional. This limit does not include magnesium naturally present in food.
• Magnesium supplements may interact with certain medications and can accumulate in individuals with impaired kidney function.

Product Reference: 

Magnesium Complex Supplement - Magnesium 500 mg Per Serving - 4 in 1 High Absorption Blend.

Helpful Tip: A product labeled “500 mg” may refer to the weight of the magnesium compounds rather than the amount of elemental magnesium. Check the Supplement Facts label for the actual elemental magnesium content.

Evening primrose oil contains gamma-linolenic acid (GLA), an omega-6 fatty acid.

It is commonly marketed for breast tenderness, skin health, and menopause-related symptoms.

What Does the Research Say?

Current evidence does not reliably demonstrate that evening primrose oil improves hot flashes, breast tenderness, or mood symptoms during menopause.

It should not be considered a proven treatment for menopause symptoms.

Safety Considerations:

• Possible side effects include gastrointestinal discomfort, headache, and nausea.
• Evening primrose oil may interact with certain medications, including anticoagulants.
• Discuss its use with your healthcare provider, particularly if you take prescription medications or have a bleeding disorder.

Product Reference: 

NOW Supplements, Super Primrose 1300 mg with GLA

If you're considering a supplement during perimenopause or menopause:

• Discuss the product with your healthcare provider, especially if you take prescription medications.
• Review the Supplement Facts label and avoid combining products with overlapping ingredients.
• Look for independent quality testing, such as USP or NSF certification, when available. Quality testing does not establish that a product effectively treats menopause symptoms.
• Be cautious of products promising to “balance hormones,” “reverse menopause,” or provide guaranteed symptom relief.
• Remember that supplements are not substitutes for proven hormonal or nonhormonal treatments when symptoms significantly affect your quality of life.

MidwifeNora's Educational Reminder: These products are included for educational reference and are not endorsements of their effectiveness for treating menopause symptoms. Individual risks and benefits should be reviewed with your healthcare provider.

Perimenopause and menopause can bring physical and emotional changes that affect everyday life. Mind-body practices and simple comfort measures may help you manage stress, improve emotional well-being, and cope with bothersome symptoms.

Although these approaches can complement medical care, not all have been proven to directly reduce hot flashes or night sweats.

Relaxation techniques can help reduce stress and promote a sense of calm.

Consider trying:

• Deep Breathing: Practice slow, comfortable breathing when feeling stressed or overwhelmed.
• Meditation & Mindfulness: Set aside a few minutes each day to focus on the present moment.
• Progressive Muscle Relaxation: Gently tense and release different muscle groups to reduce physical tension.
• Guided Imagery: Use calming audio recordings or visualization exercises to encourage relaxation.

What Does the Research Say?

These techniques may support emotional well-being and stress management. However, paced breathing and relaxation exercises have not consistently demonstrated meaningful reductions in hot flash frequency or severity.

Helpful Tip: Choose a relaxation practice you enjoy and can incorporate into your daily routine.

Cognitive behavioral therapy is a structured, evidence-based approach that helps individuals identify and change unhelpful thought patterns and behavioral responses.

How Can CBT Help During Menopause?

Menopause-focused CBT may help:

• Reduce how bothersome hot flashes and night sweats feel.
• Improve coping strategies and symptom-related distress.
• Address sleep difficulties associated with menopause.
• Support emotional well-being during the menopause transition.

What Does the Research Say?

CBT has evidence supporting its use for managing the impact of vasomotor symptoms. It may improve how individuals experience and cope with symptoms, even when the number of hot flashes does not substantially decrease.

Helpful Tip: Ask your healthcare provider about therapists or programs offering menopause-focused CBT. CBT for insomnia (CBT-I) is also an effective treatment for chronic insomnia.

Acupuncture is a traditional practice involving the insertion of thin needles into specific areas of the body by a trained practitioner.

Some individuals explore acupuncture for menopause-related symptoms, including hot flashes, sleep disturbances, and stress.

What Does the Research Say?

Research findings are mixed. Although some studies report improvements in symptoms, acupuncture has not consistently demonstrated benefits beyond sham acupuncture for hot flashes.

The Menopause Society does not recommend acupuncture as an evidence-based treatment specifically for vasomotor symptoms.

Safety Considerations:

• Choose a properly trained and licensed practitioner.
• Ensure sterile, single-use needles are used.
• Discuss acupuncture with your healthcare provider if you take anticoagulants or have a bleeding disorder.

Simple adjustments may help you feel more comfortable during hot flashes or night sweats.

Consider:

• Dressing in lightweight, breathable layers.
• Keeping a fan nearby.
• Using lightweight bedding.
• Maintaining a comfortably cool bedroom.
• Keeping cool water available.
• Changing damp clothing or bedding when needed.

What Does the Research Say?

Cooling strategies may improve comfort during an episode, but evidence that they prevent hot flashes or substantially reduce their frequency is limited.

These measures can still be useful for personal comfort.

If hot flashes, night sweats, mood changes, or sleep disturbances interfere with your quality of life, you do not have to manage them without help.

Effective treatment options are available, including menopausal hormone therapy for appropriately selected individuals and evidence-based nonhormonal treatments.

Your healthcare provider can help you review your symptoms, medical history, preferences, and available treatment options.

Remember: Natural approaches can be valuable for comfort and emotional well-being, but they are not always substitutes for treatments proven to relieve bothersome menopause symptoms.

For more information about menopause symptoms, treatment options, and natural approaches, explore these trusted medical resources:

The Menopause Society – Evidence-based information about menopause, symptom management, and treatment options.

https://menopause.org/

National Institutes of Health (NIH) – Research-based information about supplements, acupuncture, and other complementary approaches to menopause symptoms.

https://www.nccih.nih.gov/health/menopausal-symptoms-and-complementary-health-approaches-what-the-science-says