By Danielle MacDowell M.S., CNS, LDN, M.Ed, BCBA, LABA
Main Takeaways
- Perimenopause is about more than changing hormones. Hormonal shifts can influence interconnected systems throughout the body, including the brain, nervous system, gut microbiome, and metabolism.
- Your nervous system is part of the perimenopause picture. Changes in estrogen and progesterone can affect neurotransmitter systems involved in mood, cognition, sleep, and stress response.
- The gut and reproductive hormones may influence one another.
- The estrobolome is one piece of the gut-hormone puzzle. Gut microbes and their enzymes, including beta-glucuronidase, may influence how estrogen is processed and reabsorbed.
- Foundational nutrition matters. Plant diversity, adequate fiber, colorful foods, protein, healthy fats, hydration, regular bowel movements, and movement can help create an environment that supports hormonal health.
- There is no single approach to perimenopause. Your symptoms, health history, physiology, preferences, and goals all matter when determining what kind of support may be appropriate.
- Supporting your body doesn’t have to mean fighting against it. Perimenopause can be an opportunity to pay closer attention to nourishment, recovery, sleep, movement, stress, and the signals your body is giving you.
Table of Contents
When we think about perimenopause, we often think about a hormonal transition.
And, this isn’t wrong.
There is no denying that during perimenopause, there is a significant shift in reproductive hormones.
But hormones are only part of the story.
We are learning more about how perimenopause involves a much broader network of interconnected systems, including the brain, nervous system, gut microbiome, metabolism, and reproductive hormones.
This is one reason I believe it is so important to take an integrative approach when supporting women through this stage of life.
Perimenopause Symptoms
Despite what we have all heard, perimenopause symptoms span beyond irregular periods, hot flashes and night sweats. For many women, this stage of life can bring unanticipated changes that seem to have very little to do with hormones—but in fact, they have everything to do with the hormonal shifts that are happening in the body.
Beyond the traditionally discussed symptoms, perimenopause may show up as:
- Anxiety that feels different than it used to
- Disrupted sleep
- Brain fog
- Difficulty with attention and focus
- Changes in mood
- Hot flashes
- Fatigue
- Changes in body composition
- Feeling like your body is responding differently than it once did
Perimenopause is Also a Nervous System Transition
For many women, perimenopause brings about a significant shift-not only from the physical side, but from the mental and emotional side, leaving women confused, exhausted, and unsure of what is “normal.”
Because the symptoms that many women experience aren’t spoken about nearly enough, many women aren’t prepared for the ways in which the body (and mind) may be impacted, which is why I felt it important to put out this blog.
Estrogen, Progesterone & Your Mental Health
We often think of estrogen and progesterone primarily in terms of reproductive health. But these hormones also interact with the brain and nervous system, influencing neurotransmitter systems involved in mood, cognition, stress response, and sleep.
Can we say brain fog anyone?
This may help explain why some of the changes women experience during perimenopause can feel so different from what they have experienced before. Changes in mood, anxiety, memory, concentration, and sleep can be reflective of the way the brain and nervous system are responding to changing hormonal signals.
Importantly, these changes don’t necessarily mean that symptoms will continue indefinitely.
The brain and nervous system are capable of adapting to changing hormonal signals. As the nervous system adjusts to the new hormonal environment, some symptoms may lessen over time.
And there is another layer to consider…
By midlife, many women have spent years managing work, family, caregiving, relationships, chronic stress, inadequate sleep, and the demands of everyday life.
In other words, the hormonal transition isn’t happening in a vacuum. It may be occurring in a nervous system that has already been carrying a significant load.
This is why supporting the nervous system during perimenopause is about much more than simply trying to “balance hormones.” Breathwork, meditation, yoga, time in nature, movement, social connection, and practices that support parasympathetic activity (your rest and digest state) all have a place in a comprehensive approach. These strategies may help support stress regulation, sleep, and mood.
What Does the Gut Have to Do With Perimenopause?
Quite a bit, believe it or not…
The gut microbiome is not separate from the rest of the body. It interacts with the immune system, metabolism, nervous system, and hormone-related pathways.
Interestingly enough, research in animal models has found that removal of the ovaries has been associated with changes in intestinal permeability and inflammation, suggesting that the relationship between reproductive hormones and the gut may be bidirectional.
But before we jump into any definitive conclusions, we should be careful. This is because animal findings do not always neatly translate to humans. But this research does give researchers (and us) important clues about how interconnected these systems may be.
And from an integrative standpoint, this reinforces how I practice clinically.
Rather than choosing just one area to focus on—the gut, hormones, or the brain—I look at how these systems may be influencing one another. Because, frankly, you shouldn’t have to choose just one. The body doesn’t operate in isolated systems. And supporting one area often requires considering what is happening in another.
Taking this broader view allows us to look at the whole picture rather than focusing on a single symptom or system in isolation.
The Estrobolome: Another Piece of the Gut-Hormone Puzzle
One particularly interesting area of research is the relationship between the gut microbiome and estrogen metabolism.
You may have heard the term estrobolome. It refers broadly to the collection of gut microbial genes and enzymes involved in estrogen metabolism. And one enzyme that has received special attention in this space is beta-glucuronidase. Certain gut bacteria produce beta-glucuronidase, which can influence the reabsorption of estrogen and other compounds processed for elimination. In other words, high levels of this enzyme can increase estrogen reabsorption, which can make hormonal balance even more off-kilter.
But this is also an area where I think it is important not to oversimplify by focusing on one enzyme. Instead, the broader picture matters. Are you sensing a theme here? Dietary fiber, plant diversity, bowel regularity, microbial diversity, alcohol intake, overall diet quality, and the individual’s health history can all be relevant parts of the conversation when considering the estrobolome and how the body (and the gut) process estrogen.
How To Support A Healthy Gut Microbiome
This is where foundational nutrition becomes incredibly important.
Rather than immediately gravitating to a long list of supplements, when possible, I prefer to start with the basics:
- A diverse range of plant foods
- Adequate dietary fiber
- Resistant starches when tolerated
- Colorful fruits and vegetables
- Polyphenol-rich foods such as berries, pomegranate, green tea, herbs, and spices
Adequate protein and healthy fats - Fermented foods when appropriate and tolerated
- Regular movement
- Adequate hydration
- Attention to alcohol intake
- Supporting regular bowel movements
- Adequate sleep
These strategies help create an environment that supports digestion, metabolic health, microbial diversity, and the many physiological processes involved in hormone metabolism.
Perimenopause Is a Whole-Person Transition
Perhaps the biggest takeaway I want to impart to you is the importance of stepping back from the idea that perimenopause is simply about declining estrogen.
Hormones matter.
But so do the systems that interact with them…..
The gut microbiome matters.
The nervous system matters.
Sleep matters.
Nutrition matters.
Movement matters.
Stress and recovery matter.
Relationships and social connection matter.
And so do meaning and purpose.
Perimenopause isn’t happening in isolation. It is happening within an entire body, mind, and real life.
Supporting Your Body Through the Transition
Perimenopause is a significant physiological transition, but it doesn’t have to become a season of fighting against your body.
It can be an opportunity to pay closer attention to what your body may be asking for.
- More nourishment.
- More recovery.
- More protein and fiber.
- More plant diversity.
- More movement that supports you rather than exhausts you.
- More attention to sleep.
- More nervous-system support.
And, when appropriate, more individualized investigation into the factors that may be contributing to how you feel. There is no single perimenopause nutrition plan that works for every woman.
Your symptoms, history, physiology, preferences, and goals all matter.
That is where personalized nutrition care can make an important difference.
1:1 Consultations and Functional Testing with True Potential Nutrition
I am a functional nutritionist, specializing in gut health, hormonal health, mental health, and neurodiversity. If you are looking for personalized nutrition recommendations or functional testing, visit this link to set up a free discovery call to find out how I can help you reach your health and wellness goals.
*As always, if you are considering making any changes to medications, supplements, diet, or lifestyle, reach out to your practitioner so that they can guide you through the process.
References & Research Notes
A Note on the Research
This article is an educational overview based in part on material presented through professional education on perimenopause, including the American Nutrition Association’s Perimenopause Virtual Symposium (2025) and related professional lectures.
This information is for educational purposes only and does not constitute medical advice. Changes to diet, lifestyle, or supplement use should be discussed with your healthcare professional, particularly if you have a medical condition or take medication.
- Veincek, S. (October 24, 2025). Balancing Perimenopause: Navigating the Transition—Addressing Treatment and Lifestyle Protocols. Perimenopause Virtual Symposium. American Nutrition Association.
- Minich, D. (October 24, 2025). A Root-Cause Functional Medicine Approach to Perimenopause: Addressing the Physical, Emotional, Mental, and Spiritual Matrix. Perimenopause Virtual Symposium. American Nutrition Association.
- Freeman, C. (2023). Hormone Deep Dive: Perimenopause. Professional Lecture. Accessed September 13, 2026.
