If you are pregnant, breastfeeding, or taking anticoagulants, corticosteroids, hormone therapy, insulin-sensitizing medications, or sedatives, consult your healthcare provider.

Many new prenatal vitamins have entered the market which have methylated folate instead of folic acid. Methylated folate is a downstream metabolite of folic acid. Although some people may have difficulty metabolizing folic acid (associated with a genetic mutation, MTHFR), it is very important to realize that only folic acid has been shown to prevent NTD (neural tube defects). Although methylated folate has been shown to result in sufficient blood folate levels, no study exists proving that methylated folate prevents neural tube defects or compares methylated folate vs folic acid. No study like this will ever exist because when something clearly prevents a bad outcome, like a birth defect, you would never allow a group of pregnant people to be at risk for this outcome when you could prevent it. I recommend you take at least 400 mcg of folic acid, in the form of folic acid. If you love a prenatal that has methylated folate, take an additional folic acid supplement. Methylated folate may help a small group of people who have problems metabolizing folic acid when they are not pregnant, but if you are trying to conceive, I recommend adding folic acid as well.

During perimenopause, your body is navigating a wave of hormonal changes—fluctuating estrogen and progesterone can affect everything from mood and metabolism to sleep and cycle regularity. Lifestyle support is not optional; it’s foundational. The more consistent you are with the basics, the more resilient your system becomes through this transition.

Start with nutrition. A diet rich in colorful vegetables, fiber, high quality protein, and healthy fats will help stabilize blood sugar, reduce inflammation, and support hormone balance. Fiber is particularly important. It supports gut health and estrogen metabolism, both critical during perimenopause. Try to limit alcohol, highly processed foods, and excess caffeine. These can disrupt sleep, worsen hot flashes, and increase anxiety.

Movement matters. Regular physical activity can reduce hot flashes, improve sleep, and help maintain muscle and bone strength as estrogen declines. I recommend a mix of resistance training, aerobic exercise, and lower-intensity movement like yoga or walking. Even 30 minutes a day can make a difference.

Sleep can become more elusive in perimenopause, so prioritizing good sleep hygiene is key. Aim for 7–9 hours per night. Keep a consistent bedtime, avoid screens before bed, and try wind-down routines like reading, stretching, or mindfulness. If sleep disturbances persist, talk to your doctor, supporting sleep may also support hormonal rhythm and emotional balance.

Stress is a major disruptor of hormonal health. Cortisol, your primary stress hormone, competes with progesterone and can worsen symptoms like mood swings, fatigue, and insomnia. Incorporating daily stress-relieving practices like journaling, breathwork, or even just saying ‘no’ more often can go a long way. Emotional resilience is just as important as physical.

Track your symptoms and your cycle. Many women experience irregular periods, skipped cycles, or worsening PMS during perimenopause. By tracking these changes, you can better advocate for yourself and recognize when additional support is needed.

Perimenopause is not just a time of loss, it’s a time of recalibration. With the right foundational habits, you can feel strong, supported, and informed about what your body needs.