Perimenopause Isn’t Just About Hormones
Let’s get real about perimenopause: common symptoms women experience during this transition include hot flashes, mood swings, low libido, and weight changes. But if you’ve been told the only solution is hormone replacement therapy (HRT), you’re not getting the full story.
Yes, HRT can be a powerful support tool, but it’s not the only tool. We recently sat down with renowned functional medicine expert Dr. Deanna Minich to bust the myth that perimenopause is only a hormone problem and that HRT is the only answer. Spoiler alert: It’s not, and here’s why.
Perimenopause Isn’t an Estrogen Deficiency, It’s a Systems Shift
Your hormonal symptoms don’t exist in isolation. Behind the scenes, your gut, liver, brain, thyroid, and adrenal systems are all influencing how your body produces, processes, and eliminates hormones. Before we even think about HRT, we need to assess the HPTA-GLOA. The short winded way of referring to the Hypothalamic Pituitary Thyroid Adrenal Gonadal Limbic Ovarian Adrenal Axis. Yes, it’s a mouthful but this axis governs our endocrine system, mood, metabolism, inflammation, detox and more. Without first addressing these body systems and understanding the root of hormonal symptoms, HRT alone may be missing the mark for many women entering this phase of life.
It’s Not Just About Hormone Levels
Dr. Minich explains her root-cause framework for hormone health, centered on the five key phases of hormone processing:
Synthesis
Transport
Activation
Metabolism
Excretion
In other words, it’s not just how much hormone you have, it's how your body makes, moves, uses, and clears those hormones. This entire process is heavily influenced by systems you might not associate with hormones: your gut, liver, brain, and even your nervous system. Many women begin hormone therapy without ever addressing:
Gut imbalances that impair detox
Liver congestion that slows hormone clearance
Nutrient depletions that impact hormone synthesis
Nervous system dysregulation that disrupts brain-hormone communication
Without these foundations in place, HRT might feel like putting a fresh coat of paint over a crumbling wall.
What to Do Before Starting HRT to Make It Effective
1. Support the Full Hormone Cascade:
Hormones need support through each phase, from synthesis (making the hormone), to transport, activation, metabolism, and finally excretion. Optimizing these steps ensures that HRT works with your body rather than just replacing what's missing.
2. Assess Liver & Detox Capacity:
Your liver clears estrogen and other hormones through bile. If detox pathways are overwhelmed or sluggish, hormone replacement may stack up instead of metabolizing efficiently. Optimizing liver function through diet, hydration, and targeted support lays critical groundwork.
3. Prioritize Gut Health & Microbiome Balance:
Gut dysbiosis or poor barrier function (leaky gut) can impact estrogen clearance and upregulate systemic inflammation. Supporting digestion, improving microbiome diversity, and lowering intestinal permeability helps your body process hormones more effectively.
4. Address Endocrine Disruptor Load:
Toxins like BPA, phthalates, pesticides, or mold exposure can disrupt hormone receptors and lead to resistance, even with HRT. It is crucial to clean our internal environment to reduce interference before hormone dosing begins.
5. Support Your HPTA‑GLOA Axis:
The HPTA‑GLOA regulates mood, metabolism, inflammation, and stress responses. Nervous system regulation like sleep, stress management, breathwork, and boundary setting are vital for hormonal systems to function effectively.
6. Use Phytonutrients Strategically:
Phytonutrients are plant compounds such as maca that support hormone balance naturally. These can provide meaningful support even when HRT isn’t indicated or fully effective.
Ready to Take a More Root-Cause Approach to Hormonal Health?
If you’ve been feeling lost in the perimenopause fog, this conversation offers clarity—and hope. It’s about empowering you to understand the deeper why behind your symptoms and giving you options beyond the prescription pad.
If you’re navigating perimenopause and feeling like you’re not getting the full picture, it may be time to dig deeper. In our 1:1 work we can help you connect the dots between your hormones, gut, detox pathways, and nervous system to build a personalized healing plan that actually works.Whether you’re exploring HRT or want to feel better without relying on hormone therapy, we can help you understand what your body needs and how to support it from the ground up. This isn’t one-size-fits-all care. It’s deep, individualized work designed for long-term results. Learn more about our 1:1 Functional C.A.R.E Method™ here.
