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This article contains scientific references. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.

How to Balance Hormones in Menopause: A 3-Step Guide

Written by Michael Ruscio on June 25, 2024

Supporting Hormonal Health with Simple Strategies

In the menopause phase of life, women may struggle with unpleasant symptoms like hot flashes, night sweats, mood changes, and disrupted sleep for years [1]. 

Since these symptoms are the result of shifting hormones, some women may feel like they just need to wait it out, and eventually things will even out. Others may try various supplements, tests, or diet programs to find relief without much success. 

While we can’t stop the hormonal shifts during menopause, there are many extremely effective strategies women can use to lessen their impact. In this article, I’ll share how to balance hormones in menopause in 3-steps. 

Before I dive into those details, let me share some important background information about menopause and the wide array of symptoms it can cause.

What is Menopause? 

Menopause is a natural process that marks the end of a woman’s reproductive years. It signifies the end of ovarian function meaning the ovaries are no longer releasing eggs and their production of estrogen and progesterone is greatly reduced. 

The menopausal transition can be broken down into three phases. Here’s a table detailing each one, the hormonal changes that occur, and the associated symptoms:

Phase Hormonal Changes Symptoms
Perimenopause (between ages 45–55) [1, 2, 3, 4, 5, 6] Estrogen and progesterone levels are declining
  • Irregular menstrual cycles
  • Hot flashes
  • Night sweats
  • Irritability
  • Mood swings
  • Insomnia
  • Increased fat
  • Decreased muscle mass
Menopause (1 specific point in time 12 months from the last menstrual period, average age 51) [2] Very low estrogen and progesterone levels
  • Absent menstrual period
Postmenopause [1, 3, 6, 7] Very low estrogen and progesterone levels
  • Hot flashes
  • Vaginal dryness, burning, itching
  • Painful intercourse
  • Thinning of the vaginal lining
  • Loss of sex drive
  • Lower urinary tract symptoms (frequent and strong urges to pee, need to pee at night, urinary incontinence (being unable to hold it in), stress incontinence (accidentally peeing when you cough, laugh, sneeze, run, or lift something heavy, all of which put stress on the bladder), recurrent urinary tract infections
  • Sleep disturbances (sleep-onset insomnia, obstructive sleep apnea)
  • Increased body fat
  • Decrease in muscle mass

As you can see, the 6–11 years during which a woman’s estrogen levels start to decline and bottom out can come with a wide range of unpleasant symptoms [1]. For most of the women who have symptoms, they’ll eventually subside (in about 4–7 years) when hormones have leveled out. 

To better understand why menopause can be so challenging, let me share some details about the roles of estrogen and progesterone in women’s health.

Estrogen, Progesterone, and Women’s Health

Estrogen and progesterone are two key hormones primarily produced in the ovaries that play a crucial role in a woman’s reproductive system and overall health [8, 9, 10]. Maintaining a healthy balance of these two hormones is essential for optimal health throughout a woman’s life.

Estrogen is responsible for reproductive function [8, 9] but also plays other important roles including:

  • Decreasing stress [11]
  • Regulating cholesterol and triglycerides to reduce cardiovascular disease risk [11]
  • Supporting bone health [11]
  • Increasing leptin (a hormone that provides a feeling of fullness) [9]
  • Possibly regulating intestinal permeability [12, 13]

Since normal levels of estrogen are protective, declining levels during menopause not only contribute to a variety of negative symptoms but can also increase the risk of a number of health conditions. 

For example, women in perimenopause and menopause can struggle with increased abdominal fat, weight gain, and metabolic syndrome [11, 14]. And during post-menopause, women can experience:

  • Higher cortisol levels during a physical stressor [11]
  • Greater risk of cardiovascular disease [11]
  • Osteoporosis from bone loss [11]
  • Unusual hunger or food cravings [9]

Progesterone acts as a counterbalance to estrogen. It plays a key role in menstruation and helps to balance the nervous system [10]. As reproductive-aged women begin to ovulate less frequently and transition to perimenopause, progesterone levels begin to fall. 

The natural decline in progesterone levels while estrogen levels are still normal or beginning to fall is one cause of perimenopause symptoms like irritability, mood swings, and insomnia [4, 5].

Menopause is a natural process but a decade of uncomfortable symptoms doesn’t sound like fun, so what can be done about it? Let me share how we approach this in the clinic.

How to Balance Hormones in Menopause: A 3-Step Guide

While menopause is a natural process that can come with mild to severe symptoms, women don’t just have to wait it out—there are a lot of natural strategies we can use to lessen the burden.  

In the clinic, we advocate for the use of a foundational model that includes diet, lifestyle changes, and gut-supportive measures first. Then, we consider herbal supplements if needed.  

It’s not that we have anything against supplements. But what we’ve found after years of treating patients is that without a solid base that addresses diet and lifestyle, supplements tend to be less effective. So you end up trying supplement after supplement without much relief.

Now let’s dive into the 3-step process we use in the clinic for supporting healthy hormone levels during the menopausal transition. 

Step 1: How to Balance Hormones in Menopause with Diet and Lifestyle 

To get the most benefit, we advocate for creating a healthy foundation first. Diet is one lever we can pull that has an undeniable impact on the symptoms of menopause—but which diet is best?

Diet for Menopause 

There isn’t one perfect diet, but a randomized controlled trial found that eating a diet higher in plants and lower in fat may reduce hot flashes by 90% (15). One reason for this improvement may be the phytoestrogen content of plants.

Phytoestrogens are compounds in plants that act like estrogen in the body. There’s a lot of high-quality research to support their use in promoting hormone balance in menopause [15, 16, 17, 18, 19, 20, 21, 22, 23, 24]. 

Foods with particularly high levels of phytoestrogens include:

  • Whole-food soy products (tofu, edamame, tempeh)
  • Flaxseeds
  • Dried fruits (like prunes)
  • Sesame seeds
  • Garlic
  • Peaches
  • Berries

Routinely incorporating these foods into a whole-foods anti-inflammatory dietary pattern (like the Paleo or Mediterranean diet) may be helpful. 

A whole-foods, balanced diet promotes digestive health, provides important micronutrients (vitamins and minerals) [25] and healthy fat intake, and balances blood sugar levels—all ingredients that are needed to support healthy hormone production.

Making dietary changes can sometimes be a challenge, especially if you’re having pretty significant symptoms. It may be best to work with a registered dietitian or certified nutrition specialist who can create a tailored plan and support you on your journey—we’re happy to help in the clinic [25]. 

In addition to following the dietary pattern that works for you, other lifestyle measures that address exercise, sleep, and stress can be extremely impactful.

Exercise for Menopause

Women in perimenopause tend to gain more fat and lose lean muscle mass. As menopause hits and postmenopause starts, the rate of fat gain can double while lean muscle loss continues making it more difficult to maintain a healthy body weight [6].

Difficulty maintaining body weight may arise from a combination of hormonal imbalances (too little estrogen and too much follicle-stimulating hormone) [7], reduced physical activity, and a slower metabolism [25].

Aside from the mental health and longevity benefits, exercise becomes a very important tool for helping menopausal women manage their weight and avoid the risk of cardiovascular and metabolic diseases [25]. Exercise can also help to alleviate menopause-related symptoms:

  • Aerobic exercise may improve the severity (but not frequency) of hot flashes [26]
  • High-intensity resistance training may increase bone density [27]

The key to exercise is to find what works for your body. If you’re new to exercise, it may be best to work with an exercise professional who can guide you. 

To get started on your own, consider aiming for 150 minutes of exercise each week—a mix of aerobics, strength training, balance, and flexibility exercises is likely best [25]. In addition, try to avoid sitting and instead move your body as much as possible, preferably in nature [28]. 

Here are some ideas to add more daily movement:

  • Walk or bike to work
  • Take the stairs instead of the elevator
  • Walk the dog or walk on your lunch break
  • Plan a family walk after dinner
  • Take a long hike on the weekend
  • Walk around the field at your child’s soccer or baseball practice

Sleep Support for Menopause

Sleep is foundational to your overall health and quality of life—high-level data shows poor sleep contributes to weight gain, obesity, and metabolic syndrome. Women in menopause tend to have disrupted sleep (for example, sleep-onset insomnia and obstructive sleep apnea), but there’s a lot we can do to improve it [3, 29, 30, 31, 32, 33, 34]. 

Getting the foundation set with diet and exercise may significantly improve menopause-related symptoms, which may mean better sleep [35]. 

Additional strategies that I discuss in my book, Healthy Gut, Healthy You include:

  • Reducing blue light exposure at night
  • Keeping the sleeping environment cool and quiet
  • Avoiding stressful pre-bed activities
  • Striving to be in bed by 10–11 pm
  • Aiming for 7–9 hours of sleep

If these strategies don’t get you over the finish line with sleep, meta-analyses have found acupuncture and mindfulness practices can improve sleep quality for women in menopause [29, 35]. 

In addition, a systematic review found that hormone replacement therapy can improve sleep in menopausal women with night sweats and hot flashes [30]. Another found that insomnia-focused cognitive behavioral therapy and an antidepressant (escitalopram—Lexapro) can improve sleep quality in menopausal women [32].

Stress Management for Menopause

Stress is a natural part of life—we have good stress and bad stress, and the key is to prevent the bad stress from taking over. 

Managing stress is particularly important for healthy hormone production. 

Consider this: the raw materials the body uses to make sex hormones (like estrogen, progesterone, testosterone, and DHEA) are the same materials it uses to make stress hormones. When stress is chronic and unmanaged, fewer resources are available to make healthy levels of estrogen and progesterone [10, 11, 36, 37]. 

Altered levels of hormones can contribute to a whole host of negative symptoms and make menopause-related symptoms worse [38]. Research suggests women in perimenopause are more likely to feel more stressed, anxious, and depressed than women in postmenopause [38]. 

So how do we overcome stress? There are several tools that can support stress resilience and reduce perceived stress in women going through the menopausal transition [38]. Here’s a table of strategies to consider:

Stress Reduction Technique Benefit
Cognitive behavioral therapy [39, 40]
  • Improves psychological well-being and quality of life
  • Reduces hot flashes, night sweats, and fatigue
Acupuncture [41, 42]
  • Improves perimenopausal depression (better than the antidepressant Prozac)
  • Reduces the frequency of hot flashes
  • Modulates hormone levels comparably to hormone therapy
Mindfulness-based interventions [39, 43]
  • Significantly improves anxiety, depression, and quality of life
  • May improve hot flashes and psychological and sexual health but more research is needed
Yoga and other mind-body practices [44, 45]
  • Improves bone health
  • Improves sleep quality
  • Reduces anxiety, depression, and fatigue
  • Yoga specifically improves a wide range of menopausal symptoms

As you can see, several options here impact stress but also target the physical symptoms of menopause. If you want to try your hand at all of these, that’s great—they have other physical and mental health benefits outside of improving menopause-related symptoms. But don’t feel like you’ve got to try them all, it’s most important to consistently incorporate what works best for you.

Once you create a healthy foundation with diet and exercise, take note of your symptoms. If things seem to be improving but aren’t quite where you want them to be, you may want to consider adding probiotics.

Step Two: How to Balance Hormones in Menopause with Probiotics

Once you’ve created a healthy diet and lifestyle, probiotics are a great addition to your foundation. 

High-quality research has found probiotics (Lacto/Bifido blends) may provide the following benefits for women in the menopausal transition:

  • Improved bone mineral density [46]
  • Reduced irritability, depression, insomnia, dizziness, hot flashes, heart palpitations, chills, and excess sweating [47]
  • Reduced anxiety and stress, and improved quality of life [48]

Aside from these menopause-specific benefits, probiotics offer a wide array of other health benefits. They improve the health of the gut microbiome, fight harmful bugs, promote a healthy immune system response, reduce inflammation, and so much more [49, 50, 51]. 

You may be wondering if there’s a menopause-specific probiotic and the answer is no. Rather than looking for a certain strain or type of probiotic, we advocate for the triple therapy probiotic approach—this just means we use all 3 categories of probiotics in combination.  

There isn’t specific research on this yet, but the vast majority of probiotic research supports the use of multiple strains—and our experience in the clinic mirrors this recommendation [52, 53, 54]. 

Here’s the probiotic protocol we use in the clinic:

how to balance hormones in menopause

Another great way to add probiotics to your foundation is to consume foods with probiotic bacteria like sauerkraut, kimchi, tempeh, miso, fermented vegetables, and kefir.

If after putting the foundations into practice consistently you’re still struggling with menopause-related symptoms, you may want to consider herbal supplements.

Step Three: How to Balance Hormones in Menopause with Herbal Supplements

As I mentioned earlier, we don’t typically start with herbal supplements. But they can be a helpful addition in cases where the foundations haven’t completely resolved symptoms. 

There are several options with good clinical evidence supporting their effectiveness in women with menopause-related symptoms. I’ve compiled them into a table describing the research we have and possible dosing guidelines based on the research. 

Herbal Supplement Evidence for Use Possible Dosing
Black cohosh [55, 56]
  • Improves physical, emotional, and cognitive symptoms
  • Improves overall symptoms
  • Improves hot flashes
 40–120 mg/day
Resveratrol [57]
  • Reduces chronic pain in age-related osteoarthritis in postmenopausal women
  • Improves menopause-related quality of life in postmenopausal women
 150 mg/day
Ashwagandha [58]
  • In perimenopausal women with mild to moderate symptoms, improves:
    • Hot flashes
    • Night sweats
    • Depression
    • Irritability
    • Anxiety
    • Fatigue
    • Urinary problems
 300 mg twice per day for 8 weeks
Licorice [59].
  • May improve the frequency and duration of hot flashes
 1 g/day for 3 months
Vitex agnus-castus (Chasteberry) [60]
  • Reduces general menopause-related symptoms
  • Reduces vasomotor symptoms (hot flashes and night sweats)
  • Reduces anxiety
 30 mg/day for 2 months

In addition to these, a 2023 randomized controlled trial showed that postmenopausal women who took vaginal estradiol or vaginal hops (Humulus lupulus) both had similar improvements in sexual desire, arousal, and vaginal dryness [61].

There are a lot of great options here and we’ve included many of these in our women’s health products—Progest-Harmony and Estro-Harmony. I discuss this more in Healthy Gut, Healthy You, but we recommend the following protocol for women trying to balance their hormones:

  • Cycling women—Estro-Harmony (2 capsules 1–2 times per day) and Progest-Harmony (1–2 capsules 2 times per day)
  • Postmenopausal women—Estro-Harmony (2 capsules 1–2 times per day)

Just a note about safety—before you add any herbal supplement, it’s best to discuss it with your trusted healthcare provider. Not all supplements will be a good fit for you (for example, ashwagandha is in the nightshade family so it may be problematic for some with autoimmunity), and there may be interactions with medications to consider. 

Start with the Foundations for Hormone Balance

Menopause is a natural part of aging, but it can present challenges. Understanding and managing the symptoms can help lessen the burden of the menopausal transition. 

Creating a healthy foundation with diet and lifestyle (managing stress, exercising, and getting restful sleep) is the first step to supporting healthy hormone balance. Layering in probiotics can help to target menopause-specific symptoms as well as provide a whole host of other health benefits. 

If you consistently follow steps one and two but are still struggling with uncomfortable symptoms, herbal supplements may help to move the needle in the right direction. 

As always, if you need more support, we’d love to help. Contact us at the Ruscio Institute for Functional Health for an appointment.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

Dr. Michael Ruscio is a DC, natural health provider, researcher, and clinician. He serves as an Adjunct Professor at the University of Bridgeport and has published numerous papers in scientific journals as well as the book Healthy Gut, Healthy You. He also founded the Ruscio Institute of Functional Health, where he helps patients with a wide range of GI conditions and serves as the Head of Research.

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