Case Study: How Functional Nutrition Helped Sarah Navigate Perimenopause Naturally
Names and identifying details have been changed to protect patient privacy.
Meet Sarah
Feeling defeated and unrecognizable to herself, Sarah came to me seeking help. At 46 years old, she noticed within the last year that she had gradually started to gain weight, despite eating her normal diet. Even further, she was experiencing fatigue, irregular periods, and other symptoms that were interfering with her daily life.
The symptoms we noted and explored together:
Weight gain
Low energy and fatigue, particularly in the afternoon
Irregular menstrual cycles
Poor sleep, including night sweats and occasional hot flashes
Anxiety and mood swings
Bloating
Like many other women in their 40s, Sarah was told her symptoms were “normal” and “just part of getting older” when she sought out conventional help. She didn’t receive any guidance into what was truly going on. As a functional nutritionist, I aim to look beyond the symptoms and get to the root cause of the issue, starting with comprehensive testing.
Tests
In order to uncover the root of her symptoms, we focused on specific tests:
DUTCH Test
The DUTCH Test is the most comprehensive method of testing that measures your sex and adrenal hormones and their metabolites, as well as relevant nutrients and neurotransmitters.
Learn more about the DUTCH Test here!
Complete thyroid panel
FSH and LH
Fasting insulin
Comprehensive lipid panel
What Sarah’s Tests Revealed
The DUTCH Test showed Sarah was experiencing low progesterone and estradiol, as well as elevated nighttime cortisol.
Thyroid panel: Completely normal–ruling out thyroid dysfunction as the primary cause of her symptoms
Other results from her bloodwork:
Fasting insulin: 18 µIU/mL, indicating reduced insulin sensitivity
Elevated FSH and LH
The elevated FSH and LH, along with low progesterone and estrogen, suggested Sarah was experiencing reduced ovarian function. Although not uncommon during perimenopause, her elevated nighttime cortisol and insulin resistance were adding additional stress to her body, making her symptoms even worse.
The Strategy: Nutrition
In diving into Sarah’s diet and nutrition habits, the biggest thing we needed to change was simple: stop skipping breakfast.
Sarah often skipped breakfast, waiting until late morning or lunchtime to eat her first meal. Delaying her breakfast or skipping it altogether placed unwanted additional stress on her adrenal glands.
Adrenal glands are two small organs that sit on top of each kidney, responsible for producing important hormones like cortisol and adrenaline as well as playing an important role in metabolism, blood pressure, and the body’s response to stress.
I recommended her first meal to be protein-and fiber-rich and contain healthy fats within a few hours of waking. Increasing her fiber intake supported healthy bowel movements, which are important for proper estrogen elimination. Prioritizing protein (25-35 grams) and healthy fats as part of her first meal helped her maintain a healthy blood sugar.
We focused on Sarah's diet to be centered around reducing inflammation.
Meals filled with:
Colorful vegetables and fruits
Lean protein
Healthy fats
Nuts and seeds
Legumes
Minimally processed foods
We placed particular emphasis on cruciferous vegetables, including:
Broccoli
Brussels sprouts
Kale
Cauliflower
Cabbage
These vegetables contain compounds such as indole-3-carbinol (I3C) and sulforaphane, which help support the liver's natural detoxification pathways involved in estrogen metabolism.
Movement
As staying active is crucial to maintaining overall fitness, we made sure Sarah’s hormones and recovery were being supported, too.
Movement That Supported Her Body:
Walking approximately two miles daily with a friend
Walking lowers stress hormones while supporting blood sugar
Strength training 2–3 times each week
Strength training is a great tool for improving insulin sensitivity
Prioritizing consistency over intensity
Sleep
To tackle Sarah’s high nighttime cortisol, we prioritized her sleep schedule. Sarah began to establish a consistent bedtime and wake time every day, reinforcing her circadian rhythm, which in turn supported her cortisol patterns.
To read my previous blog about circadian rhythm and the sleep and metabolism connection, click here!
Supplement Support
Alongside nutrition and lifestyle changes, we used targeted supplementation to address the underlying imbalances.
NAC + Milk Thistle
These were used to support healthy liver function and estrogen detoxification pathways. These supplements can help reduce symptoms such as hot flashes, mood fluctuations, and hormone-related inflammation.
Omega-3 Fatty Acids
Omega-3s helped reduce systemic inflammation, supported brain health, and promoted healthy hormone signaling.
Phosphatidylserine
Because Sarah's cortisol remained elevated at night, phosphatidylserine was included to help promote a healthier evening cortisol rhythm, allowing her nervous system to better transition into sleep.
Magnesium Glycinate
Magnesium supported her relaxation, sleep quality, nervous system regulation, muscle recovery, and stress resilience.
Black Cohosh
Black cohosh was added to help reduce hot flashes and night sweats while also supporting mood and sleep by influencing receptors within the central nervous system involved in temperature regulation.
CoQ10
CoQ10 supports healthy ovarian function by promoting energy production within the cells and protecting against oxidative stress, which naturally increases with age. It also provides antioxidant support to reduce inflammation, improve cellular energy, and promote overall healthy aging during the perimenopausal transition.
After 3-Months…
Meeting with Sarah after three months was incredibly gratifying and encouraging, as she made many improvements to her overall health!
She reported:
Significantly fewer night sweats and hot flashes
More stable mood with noticeably less anxiety
Higher energy throughout the day
More restful sleep and fewer nighttime awakenings
Less bloating after meals
Improved digestion and more regular bowel movements
Fewer afternoon energy crashes
Reduced sugar cravings
More consistent menstrual cycles
In the case of Sarah and many women experiencing perimenopause symptoms, stress, blood sugar regulation, inflammation, liver detoxification, sleep quality, nutrition, and muscle mass can play a role as a root cause of underlying symptoms.
Sarah is an example of how health improves and symptoms begin to heal with individualized testing and a personalized protocol based on results. Not only did she receive 1-on-1 guidance from me throughout her health journey, but Sarah gained a greater confidence in not only understanding her health during perimenopause, but she also learned ways to support her body.
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