There’s been a surge of excitement around hormone therapy (HT) — and for good reason. Adding estrogen, progesterone, and even testosterone to your daily routine can be life-changing for a woman experiencing fluctuating hormone levels (and help with countless irritating symptoms). However, the way hormone therapy is often positioned — as the missing piece in your health toolbox, a cure-all for every ill — is misleading. It’s a powerful tool, yes, but not a panacea. It doesn’t undo the menopause transition and it doesn’t put the process of aging on pause.
Hormone therapy can be like the napkin you wedge under the short leg of a wobbly restaurant table. It helps stabilize one corner. But if the other legs — rest, nourishment, movement, and emotional well-being — aren’t solid, the table will still wobble.
After more than two decades of working with women and bioidentical hormones, I understand the promise and limits of any medication. Yes, micronized progesterone can be a game-changer for sleep and night sweats. And transdermal estradiol does offer powerful support for bone health, reducing vasomotor symptoms (hot flashes and night sweats), and GSM (genitourinary syndrome of menopause).
But some women, because of various health concerns, aren’t candidates for HT in the first place — or don’t find it sufficient to address their overall well-being. So what can you do if hormone supplementation isn’t right for you, or just isn’t enough? Here are other ways to shore up your resilience, broken into the most important wellness pillars for a woman in any phase of the menopause transition.
Rest and deep sleep
Sleep disturbances are often the first and most disruptive symptoms women experience during perimenopause. Hormonal fluctuations — especially declining progesterone, which happens early in perimenopause — can increase anxiety, disrupt sleep patterns, trigger early morning wake-ups, and result in a racing mind at 3 a.m. And when you’re not sleeping, everything else suffers: mood, focus, metabolism, and immune function.
Why is sleep so important? It isn’t just rest — it’s restoration. Sleep is when your body recalibrates and your brain gets a cleaning via the glymphatic system, a kind of nighttime rinse cycle. During this period, the brain clears out metabolic waste, including the plaques linked to Alzheimer’s. Without enough deep sleep, that crucial housekeeping gets skipped. Deep sleep also helps quiet cortisol and ghrelin (those stress and hunger messengers), while increasing leptin and growth hormone — key players in satiety, repair, and vitality.
When you don’t get sufficient deep sleep, it’s harder to regulate cravings, stay emotionally steady, or feel like yourself. Over time, it can nudge your body toward weight gain, blood-sugar imbalance, inflammation, and cognitive decline. Honoring your need for sleep isn’t indulgent — it’s essential care for a body in transition.
Here are non-hormonal supplements and strategies that support deeper, more restorative sleep:
- Magnesium glycinate: Calms the nervous system and relaxes muscles. Start with 200 mg at night.
- L-theanine: Promotes calm without sedation by elevating the body’s levels of GABA, dopamine, and serotonin.
- Herbs: Ashwagandha, lemon balm, passionflower, and magnolia bark are gentle-acting allies for both reducing stress and aiding sleep.
- Melatonin: You may already take this when your circadian rhythms are disrupted, like in the case of travel and time-zone changes. The natural production of melatonin decreases with aging across genders, but menopause is associated with an especially significant reduction of melatonin levels for women. Melatonin can also support bone-building via increasing the growth of osteoblasts, the cells that generate new bone tissue.
- Cooling and calming strategies: Lower your room temperature, aiming for a sleep environment around 68°F, or 20°C. Avoid caffeine within 10–12 hours of bedtime, and alcohol within 3 hours. Get some sunlight in the morning, even via a 15-minute walk around the neighborhood. Keep vigorous exercise earlier in the day, and not within 3 hours of bedtime.
Nutrition
Menopause changes how our bodies use energy, metabolize nutrients, and maintain structural health. So it’s ideal to get your eating habits in tip-top shape to support you through your change. Luckily, there are plenty of delicious ways to make that happen. Foundational nutrition strategies include:
- Protein: Aim for 20-30 g per meal to preserve muscle and stabilize blood sugar.
- Healthy fats: Omega-3s, which can be obtained from fish or algae supplements or flax and chia seeds, are especially important; they reduce inflammation and support brain health.
- Vitamin D & K2: These are essential for bone health.
- B-complex vitamins: Crucial for energy metabolism, they also aid in stress management, mood, and cognition.
- Antioxidants: You can get these from a colorful, plant-forward diet to combat oxidative stress. (The risk of cardiovascular disease also increases after menopause, and antioxidants are cancer-preventative as well.)
- Blood sugar balance: Eat balanced meals with fiber, protein, and healthy fats to avoid insulin spikes and insulin resistance. This helps reduce hot flashes and brain fog.
Think of focusing on nutrition as an invitation to expand your nourishment, not make you feel restricted. Bringing in the right nutrients lays the foundation for steadier energy, a more balanced mood, and the optimal functioning of every system in your body.
Movement and strength-building
Exercise is one of the most potent non-hormonal therapies available, yet it’s often underutilized. It improves mood, sleep, metabolism, and even hot flash frequency. As a bonus, movement helps shift the nervous system from fight-or-flight to rest-and-digest. It’s mood medicine and a stress buffer.
But “exercise” is a pretty broad term. Where should you start? Here’s what to prioritize:
- Resistance training: Try it two to three times per week to support muscle mass and bone strength.
- Weight-bearing exercise: Walking, hiking, dancing, jogging, and stair climbing all strengthen bone and can help slow bone loss, reducing the risk of fractures.
- Cardiovascular movement: Improves insulin sensitivity, heart and brain health, and thermoregulation.
- Yoga: A 2024 study showed that 60 minutes of yoga twice per week significantly reduced menopausal symptoms across physical, emotional, and urogenital domains.
Emotional well-being
Midlife brings emotional transitions just as significant as physical ones. Roles shift, priorities change, and unresolved wounds may rise to the surface. What worked before may no longer serve you.
This is a season that requires:
- Self-compassion: Releasing the need to be perfect and choosing to honor your humanness over high-functioning.
- Emotional hygiene: Incorporate practices like journaling, mindfulness, or expressive writing. Research shows that writing about what you’re experiencing improves both mood and immune function.
- Therapeutic support: Modalities like somatic therapy or Internal Family Systems (which explores the subpersonalities within each of our identities) can be incredibly effective.
- Connection: Whether through community, support groups, or meaningful conversations, being seen and supported is protective.
You’re not meant to white-knuckle your way through this period or do it all solo. Tending to your emotional landscape and seeking support for your spirit builds stability from within.
Your true menopause “prescription”
Menopause is a turning point, and hormone therapy can help, but it’s not a stand-alone solution. Your health in this phase of life is scaffolded by what you do every day: how you sleep, what you eat, how you move, and how you care for your emotional self.
Remember that menopause also isn’t a failure of the body: It’s a transition that asks for new support. And if HT isn’t right for you, or isn’t a cure-all for your symptoms, know that you still have power and options. You can build the stability you need, one steady leg at a time.
Dr. Heidi Lescanec is a Naturopathic Doctor and founder of The Pink Zones, a storytelling and research-based initiative that is pro-aging; celebrating midlife and beyond as a time of vitality, wisdom, and power. She co-leads workplace wellness programs with Menopausewize.work, helping organizations become more menopause-aware — find her on Instagram at @drheidilescanec and on Substack at @heidilescanec.
