Perimenopause: She’s More Than Simply an HRT Deficiency
Perimenopause is a time of hormonal transition in a woman’s life that often occurs in the 8-10 years before menopause (which is defined as one year after a woman’s final menstrual period). It is known as a time of “hormone chaos”, because hormones can fluctuate wildly during this time, often resulting in intense and disturbing symptoms.
Many women come to me and blame changing hormones in perimenopause alone for the symptoms they’ve been experiencing. However, it is important to note that estrogen and progesterone are not the only hormones that are in flux!
In perimenopause, we often see dysfunction in many other hormones, which can include insulin, cortisol. DHEA, testosterone, and thyroid hormones. There is an entire symphony of hormones in the background that have an impact on a woman’s ovarian function, and therefore, her estrogen and progesterone levels and their functionality.
If it was as simple as prescribing HRT alone (progesterone ± estrogen), then every woman in perimenopause would have complete relief in her symptoms. I’ve now been in practice for 13 years, and I know that it is never that simple!
It is essential that we build a woman’s health foundations, even if HRT is part of the plan. Individualized nutrition and lifestyle recommendations, targeted nutrient supplementation, and any indicated adjunctive therapies are the core of any treatment plan for a woman in perimenopause.
These foundational recommendations help to regulate the symphony of hormones (ie insulin, cortisol, thyroid hormones) that impact female sex hormones and perimenopausal symptoms. We will often see significant improvement in the intensity and frequency of symptoms when we work on the foundations, even if HRT is being used.
I will never recommend HRT alone, because perimenopausal health is affected by an entire symphony of hormones. I will always address a woman’s nutrition and lifestyle, because they are truly the backbone of health in perimenopause and beyond!
Waking Up at 3 am : A Traditional Chinese Medicine Perspective
by Anna Totzke, Registered Acupuncturist
Many people tell us they have no trouble falling asleep—but almost every night they wake up around 3 a.m. and struggle to get back to sleep.
If this sounds familiar, you’re not alone. While there can be many medical and lifestyle reasons for waking during the night, Traditional Chinese Medicine (TCM) offers another way of understanding these sleep disruptions.
The TCM Body Clock
According to TCM, each organ system has a two-hour period during the night and day when its energy, or Qi, is most active.
The hours between 1 a.m. and 3 a.m. are associated with the Liver, while 3 a.m. to 5 a.m. are associated with the Lungs.
Waking consistently during these times may provide clues about underlying patterns of imbalance.
Waking Between 1 a.m. and 3 a.m.
From a TCM perspective, this time is connected with the Liver.
The Liver helps maintain the smooth flow of Qi and Blood throughout the body. When Liver Qi becomes stagnant—often due to ongoing stress, frustration, or emotional tension—it can interfere with restful sleep.
Common signs that may accompany waking during this time include:
- Feeling stressed or overwhelmed
- Neck and shoulder tension
- Frequent headaches or migraines
- Irritability
- PMS or hormonal fluctuations
- Grinding your teeth during sleep
Waking Between 3 a.m. and 5 a.m.
This time corresponds to the Lung system.
The Lungs govern breathing and are associated with both physical and emotional well-being. Waking during these hours may occur alongside:
- A lingering cough or congestion
- Seasonal allergies
- Shallow breathing
- Grief or sadness
- Feeling tired despite getting enough hours of sleep
Not everyone waking at this time has a Lung imbalance, but it is one piece of information that is taken into consideration practitioner considers during an assessment.
It’s About the Whole Picture
In TCM, we don’t diagnose based on one symptom alone.
Your acupuncturist will also ask about:
- Your energy levels
- Digestion
- Stress
- Menstrual or hormonal health
- Temperature preferences (feeling hot or cold)
- Bowel movements
- Tongue appearance and pulse quality
All of these help identify the underlying pattern contributing to your sleep difficulties.
How Can Acupuncture Help?
Acupuncture aims to restore balance within the body rather than simply treating the symptom of waking during the night.
Depending on your individual pattern, treatment may help:
- Calm the nervous system
- Reduce stress and muscle tension
- Promote the smooth flow of Qi
- Support healthy sleep cycles
- Address underlying imbalances affecting sleep
Many patients notice they begin sleeping more deeply and wake less frequently as treatment progresses.
Simple Tips to Support Better Sleep
Along with acupuncture, these habits may help improve sleep quality:
- Keep a consistent bedtime and wake-up time.
- Reduce screen time for at least one hour before bed.
- Limit caffeine later in the day.
- Avoid heavy meals or alcohol close to bedtime.
- Practice deep breathing, gentle stretching, or meditation before sleep.
- Keep your bedroom cool, dark, and quiet.
Here are 5 key ways Osteopathic Manual Therapy (OMT) helps with headaches:
- Reduces muscle tension and myofascial restrictions in the neck, head, and shoulders
Gentle techniques like myofascial release, soft tissue massage, and muscle energy target hypertonic muscles and fascial layers that contribute to tension buildup and referred pain. Sustained gentle pressure or light stretching releases trigger points, spasms, and adhesions, lowering the mechanical strain that triggers or worsens headaches.
- Restores mobility and alignment in the cervical spine, cranium, and related structures. Articulation, gentle joint mobilization, cranial osteopathy, and balanced ligamentous tension gradually free restrictions in the upper cervical vertebrae, occiput, temporomandibular joint, or cranial sutures. This improves biomechanical function, reduces nerve irritation or compression and eases stiffness without force.
- Manages pain pathways through techniques such as counterstrain, myofascial release, and gentle soft tissue work to influence the innate mechanisms of healing, protection and repair of the body.
- Improves circulation, lymphatic/venous drainage, and reduces inflammation. Rhythmic soft tissue techniques, venous sinus drainage (e.g., gentle cranial holds), and myofascial approaches enhance blood flow, lymphatic return.
- Enhances autonomic nervous system balance and holistic regulation. Gentle OMT shifts toward parasympathetic dominance (rest-and-digest state), reducing sympathetic overactivity that amplifies stress, vascular changes, or tension in headache-prone individuals. By addressing interconnected restrictions (e.g., thoracic or pelvic influences on posture and cranial base), it promotes overall relaxation, better sleep, and resilience against triggers.
PCOS is now named PMOS: Polyendocrine Metabolic Ovarian Syndrome. Here’s why I’m Thrilled About it!
by Melanie Reidl, Naturopathic Doctor
PCOS officially got a new name this month and I’m thrilled about it! It changed because the old name never reflected the full picture of this condition.
A May 2026 paper published in The Lancet announced that PCOS will now be called PMOS: Polyendocrine Metabolic Ovarian Syndrome. For decades, the name Polycystic Ovarian Syndrome made the condition sound like it was strictly an ovary issue.
In addition to reproductive and endocrine (hormone) health challenges, women with PMOS often deal with health challenges beyond their ovaries. They can also struggle with their metabolic, cardiovascular, dermatological, and psychological health.
Common conditions associated with PMOS include:
~Weight gain
~Anxiety
~Depression
~Acne
~Fatty liver disease
~Cardiovascular risk
~Metabolic dysfunction
~Insulin resistance
~Inflammation
~Infertility
The Lancet paper points out that the old name obscured the condition’s broader endocrine and metabolic features and contributed to delayed diagnosis, fragmented care, stigma, and confusion.
With a new name that conveys its multi-system impact, this is one step in the right direction for greater awareness, diagnosis, and comprehensive medical care for women with PMOS.
The name PMOS finally reflects the comprehensive, evidenced-based, compassionate care I provide for this group of women. <3
Your Fatigue is not “Fine”! Find Real Answers with Naturopathic Medicine
By Dr. Melanie Reidl, Naturopathic Doctor
Your Doctor told you your labs are “fine” but you’re exhausted and not feeling like yourself. You may be struggling with your metabolic and mental health, too.
In my view, this is unacceptable. First, we need to look deeper and ensure that we have done the correct labs (bloodwork). Your labs are your data; and that data is powerful insight into your health. Not only would we want to prepare a requisition with the appropriate blood tests and obtain results within the normal range, we actually want them to fall within an “optimal” range for best health outcomes and to prevent deficiencies.
Once a patient’s baseline values have been established for important tests in the assessment of fatigue (ie CBC, iron panel, vitamin B12, thyroid panel, insulin/glucose) we can better understand how to individualize the treatment plan. We would determine specific nutritional supplements to move the values into the optimal range, which has patients feeling significantly better!
In addition to bloodwork, a comprehensive treatment plan for fatigue incorporates individualized diet and lifestyle modifications to improve a patient’s overall energy levels.
As an ND who runs bloodwork on most of my patients, I can honestly say that labs provide powerful insight into our health, and they are often the missing piece in patients feeling their best!
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