Integrative Health Blog

Menopause and Perimenopause:  An Integrative and Preventive Medicine Approach

Posted by Dawn Cannon MD, MS on Thu, Jun 06, 2019

menopause integrative medicine Wash DC

Menopause is defined as the permanent cessation of periods resulting from the loss of ovarian follicular activity. Menopause is 12 consecutive months with no period, and this is only known with certainty in retrospect.  Perimenopause is the two to eight years preceding menopause and one year following the final menses.

Interestingly, we women begin life with all the follicles we will ever have! Throughout our lives, through ovulation and apoptosis (the dying off of cells), we lose follicles. Women experience menopause when the follicles in their ovaries are exhausted. Think of it as the cycle of the ovaries- first they are asleep, then at birth they wake up, and once they have served their purpose, they go back to sleep again.

In industrialized nations, menopause usually occurs between ages 48-52, with the mean age in the U.S. at 51 years. Menopause occurring in a woman under the age of 40 is considered premature menopause. Factors that can affect when a woman goes into menopause are genetic factors, environment, lifestyle, and systemic diseases, and an integrative and preventive medicine approach takes these factors into consideration. Genetics plays a key role as a woman’s age at menopause is associated with her mother’s menopausal age.

Symptoms and Concerns of Perimenopause and Menopause

Vasomotor/Hot Flashes

A hot flash or vasomotor flush is the result of the brain mistakenly thinking that your body is overheated and then starting a chain reaction to try to cool it down. Your brain’s reaction is probably caused by changes in your hormone levels as you reach the age where you will no longer be fertile. The occurrence and intensity of hot flashes will vary based on genetics, environmental factors, obesity, lifestyle factors and your emotional state.

Disrupted Sleep

Sleep is critical for physical and emotional health! Hot flashes, depression, anxiety and muscle or joint pain can be exacerbated with poor sleep.

Sexual Health Effects

Genitourinary syndrome of menopause is a condition that can include painful sex, vaginal dryness, itching or discharge, and recurrent urinary tract infections (UTI).


Low estrogen is a risk factor for osteoporosis. Other risk factors include alcohol consumption, low calcium, corticosteroid use, smoking and a sedentary lifestyle. Menopause will lower estrogen levels, but other factors can be modified to maintain good bones.

Cognitive Issues

Forgetfulness is common with fluctuating estrogen levels. Really!

What kinds of things have changed for you as you approach menopause?

Integrative or Functional Medicine Approaches to Peri/Menopause Include PREVENTION!

The CDC has a list of concerns for Peri/Menopausal women, and the list includes cancer, heart disease, chronic lung disease, cerebrovascular disease, Alzheimer’s, diabetes, accidents, and chronic liver disease. What do most of these have in common?  Inflammation!

Some basic advice on managing menopause/perimenopause symptoms is to keep your Detoxification UP and your Inflammation DOWN. Here are helpful ways to keep things in check:

Stress Management: Simple Tips with BIG Effects (Adapted from Mary Bove ND)

  • Be good to and Believe in Yourself
  • BE! In the moment
  • Focus on the blessings in life
  • BEGIN! Do the things you have always wanted to do
  • Smile and laugh more 😊
  • Include FUN!
  • Breathe deeply, relax your shoulders
  • Use exclamation points!
  • Use this very magical, powerful word when necessary: “No.”

Minimize Your Toxic Load with a Clean Diet

Eat a clean, plant-focused, nutrient-dense diet.

  • Food should be organically grown, pesticide, hormone and antibiotic free as much as possible
  • Eat non-GMO certified
  • Eat high quality local food (farmers markets and such)
  • Eat wild caught, smaller fish
  • Avoid packaged food (avoid anything your grandmother would not recognize as food!)
  • Minimize sugar and food quickly metabolized to sugar
  • Emphasize leafy, cruciferous and colorful veggies

Avoid Heavy Metals and Endocrine Disruptors

Lead, arsenic, mercury, dioxin, aluminum, atrazine, BPA and phthalates can be found in food, water, personal care products, “silver” fillings (mercury), water bottles and register receipts (BPA), pesticides, fire retardants and many more places- and can disrupt hormones.


Detoxification will support the systems that remove what your body sees as toxic. This includes hormones that you may have too much of!

Simple ways to detox include regular exercise (get out, breathe hard and sweat!), eating foods and herbs such as garlic, onion, cilantro, or adding detoxification therapies to your health routine such as massage, acupuncture, infrared sauna and colon hydrotherapy. Not only do these therapies assist with removing toxins from the body, but they leave you feeling relaxed and rejuvenated.

Helpful Supplementation

Start with a robust multivitamin as a base. Check Vitamin D levels for optimum level of 50-80 mg. K2 should be included with D3 supplementation. You may need a robust methylfolate, methyl B 12 and/ or P5P supplement.

Vitamin C should be buffered, and you may benefit from zinc supplementation. Most people see benefits from magnesium, but a specific kind of magnesium may be helpful for you. Cod liver oil is a great way to supplement vitamins D and A, as well as omega 3 fats.

Don’t guess, get tested by an integrative or functional medicine physician and supplement and recheck as needed.


Women in perimenopause or menopause may benefit from ashwagandha, rhodiola rosea, scutellaria baicalensis or glycyrrhiza glabra root, or black cohosh for fatigue or to decrease inflammation.


Discuss your hormone replacement goals with your provider. Should you be replacing hormones? Do you have a family or personal medical history to factor in the decision? Have you minimized hormone disruptors as much as you can?

Perimenopause and menopause are part of the cycle of life.  When that time of life rolls around, consider modifying lifestyle factors to ensure this natural process is just part of the journey.


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Dr. Dawn Cannon integrative physician Wash DCDr. Dawn Cannon, MD, MS, is an integrative physician at National Integrative Health Associates in the metropolitan Washington, D.C. area. Her focus is adult primary care and preventive medicine, approached holistically. Her special interests include detoxification for the damaging effects of environmental exposures and toxins, women's health and hormones, and a functional medicine approach to finding the root cause of disease or imbalance in the body.

Topics: menopause, hormones, womens health