06/06/2026
One thing I have seen again and again in clinic over the last 20 years is that many women in perimenopause are not simply “low in oestrogen”. It is far more complex than this single hormone.
In fact, when looking at many women’s blood test patterns, oestrogen often appears to be relatively high, or poorly balanced, while progesterone seems to be the missing link.
Perimenopause is not just about one hormone dropping.
It is often a time of hormone fluctuation, stress sensitivity, blood sugar changes, poor sleep, weight gain around the middle, heavier periods, breast tenderness, irritability, anxiety and feeling like your body no longer responds the way it used to.
From a herbal medicine perspective, the aim is not to “force” hormones in one direction, but to support the whole endocrine system.
That means looking at:
• Liver and digestive health
• Blood sugar balance
• Stress and cortisol regulation
• Sleep quality
• Inflammation
• Nutrient status
• Thyroid function
• Progesterone and oestrogen balance
• Exercise type and recovery
The liver plays an important role in hormone processing, so herbs traditionally used to support liver and digestive function may be helpful as part of a wider plan. Herbs such as milk thistle, dandelion root, burdock and artichoke are often considered when looking at sluggish digestion, hormone clearance and metabolic health.
I also often consider herbs traditionally used around female hormone balance, such as wild yam. Wild yam is not the same as taking progesterone, but it has a long history of use in women’s health and may form part of a wider herbal approach depending on the individual.
Stress is another huge piece of the puzzle.
Chronic stress can disrupt the rest of the endocrine system.
When cortisol is constantly being called upon, the body may struggle with sleep, blood sugar, weight, mood, cravings and hormone balance.
This is where adaptogenic herbs may be useful. Herbs such as Withania, Rhodiola and Astragalus are traditionally used to support resilience, energy and the stress response. The right herb depends on the person, because not every adaptogen suits every woman.
Exercise also needs to be looked at carefully.
Many women hit perimenopause and think the answer is more cardio, longer runs, more classes and pushing harder. But this can backfire, especially if the body is already under stress.
Too much long-duration cardio can become another stressor on the body.
In some women, especially those already dealing with poor sleep, low resilience, blood sugar swings or chronic stress, this may contribute to higher cortisol patterns and make fat loss, particularly around the middle, much harder.
This does not mean exercise is bad. It means the right type of exercise matters.
For many women in perimenopause and beyond, I would prioritise:
• Resistance training
• Building and maintaining muscle
• Shorter, focused HIIT-style sessions where appropriate
• Walking
• Mobility and stretching
• Proper rest and recovery
Muscle is metabolically active. The more muscle we maintain as we age, the better we tend to do with blood sugar control, insulin sensitivity, strength, bone health and long-term resilience.
Long runs and excessive cardio are not always the answer, especially if the woman is exhausted, inflamed, stressed and gaining weight around the belly despite
“doing everything right”.
Sometimes the body needs less punishment and more intelligent training.
Metabolic health matters too.
For many women in perimenopause and beyond, a lower carbohydrate, higher protein, nutrient-dense diet can be incredibly helpful for blood sugar stability, weight management, cravings, inflammation and energy. I often find that when blood sugar becomes more stable, hormone symptoms can feel less chaotic too.
This is why I never look at hormones in isolation.
Perimenopause is not just a reproductive hormone issue. It is a whole-body, metabolic, stress-response and endocrine issue.
Herbal medicine works best when we look at the whole woman, not just one symptom.
If you are struggling with perimenopause, heavy periods, mood changes, anxiety, weight gain, poor sleep or symptoms that feel hormonally driven, it may be worth looking deeper than simply “you need more oestrogen”.
Progesterone, stress, liver health, exercise choice and metabolic health may all be part of the missing picture.
For bespoke 1 to 1 holistic treatment consider booking your consultation today.
Budd’s Herbal Medicine
Medical Herbalist
www.buddsherbalmedicine.com
http://www.buddsherbalmedicine.com
