Riding the Wave: Navigating Perimenopause Without HRT
Perimenopause is not for the faint of heart.
The hormone chaos. The brain fog. The random rage spikes, sleep disturbances, and hot flashes at the worst possible moment. Now add the choice (or necessity) to skip HRT, and you’re navigating with even fewer tools.
If you’re going HRT-free—or just HRT-curious and not ready—this is your survival guide.
VALIDATE YOURSELF FIRST: THIS ISN’T EASY“Why do I feel like I’m losing my mind?”
Because no one told you what perimenopause actually feels like. And if you’re also dealing with ADHD, chronic illness, or just a system that doesn’t listen to women and gender-diverse people? It’s even harder.
You are not doing this wrong. You are doing this without a map—and still finding your way.
WHY SOME AVOID HRT
There are legit reasons why people skip hormone therapy:
Medical contraindications (e.g., cancer risk, blood clot history, migraines)
High sensitivity to side effects
Personal or cultural preferences
Limited access to menopause-informed care
Trauma history or gender dysphoria
HRT is not the only way through this. It’s okay to choose something different.
WHAT YOU CAN DO WITHOUT HRT
Let’s build your toolkit.
1. Track Your Symptoms
Don’t underestimate the power of good data. You’ll spot patterns, identify triggers, and feel more in control.
Track:
Mood shifts
Sleep quality
Energy levels
Hot flashes/night sweats
Cognitive fog
Tools to try: Apps (including keeping it simple in your Notes app), digital or paper journals, simple bullet journal or voice notes.
“If you can track it, you can change it.”
2. Support Your Nervous System (DBT Style)
Your nervous system is the first responder to hormonal chaos—and if you’re not tending to it, emotional regulation is an uphill battle.
This is where DBT’s PLEASED skill kicks in.
Specifically: P = Treat Physical Illness / Tend to Physical Health
When your physical health is shaky, your emotional vulnerability skyrockets.
Try this trio:
Blood sugar balance: Eat protein, fiber, and fat every 3–4 hours
Daily nervous system support: EFT tapping, deep breathing, cold water on the face
Sleep hygiene: Magnesium glycinate, blackout curtains, screen limits
Hormones + untreated stress + blood sugar crashes = emotional whiplash. PLEASED helps lower the volume.
3. Explore Herbal & Natural Supports
First and foremost, before starting any supplements please consult with a professional to assess if they would be right for you. Even when things are deemed “natural,” they can interact with other medications or medical issues you may be experiencing. These aren’t a replacement for medical care, but they can help:
Adaptogens (ashwagandha, rhodiola) for stress
Phytoestrogen-rich foods (like flaxseed, tofu, lentils)
Black cohosh or evening primrose for hot flashes (check with your provider)
Pro tip: Work with an herbalist, naturopath, or integrative practitioner to get guidance that isn’t just based on Google searches or recommendations from friends or strangers on the internet.
4. Support Gut & Liver Detox Pathways
Estrogen is metabolized through the liver and gut. Help it flow out of your system instead of getting reabsorbed.
Drink water like it’s your side hustle
Get daily fiber: chia, oats, leafy greens
Eat anti-inflammatory foods: turmeric, berries, cruciferous veggies
THE HARDEST PART? FINDING GOOD CARE.
Not all doctors are up to date on perimenopause. Many still don’t recognize symptoms until your period vanishes entirely. (Spoiler: that’s the final boss, not the beginning.)
How to Advocate for Yourself
Ask clear questions:
“Can we discuss the possibility of perimenopause even if labs are normal?”
“Are you familiar with treating patients who don’t use HRT?”
“Can I get a referral to a menopause-informed specialist?”
Use clear language. Bring symptom trackers. Stay grounded in your experience.
You are the expert on your own body—even when the system tells you otherwise.
RECOMMENDED RESOURCES
The Menopause Society: Find certified providers
Gennev: Menopause telehealth & resources Visit here
Perimenopause Hub: A Facebook community with an expert panel for support (I am a member and on the expert panel) Join here
Hey Perry: Perimenopause support community and app Find it here
The Emotionally Organized Woman: My Facebook community where you can ask questions, find support, and get additional resources Join here
Podcast recs, books, and more. Feel free to message me on my social media channels or send an email to blairpfeiffercoaching@gmail.com
REMEMBER
This is a transitional chapter, not a permanent state.
You don’t have to suffer just because you’re not on HRT. You just need better tools—and a whole lot more validation.
Perimenopause doesn’t have to break you. You are allowed to pivot, rage, rest, and rebuild on your own terms.
You don’t need to be fixed—you need to be supported.
BONUS FREEBIE
Want hormone-friendly strategies tailored for your ADHD brain?
Grab my free ADHD & Perimenopause Starter Kit here!
Get DBT skills, nervous system support, and symptom tracking tools—all in one place.
Until next time. Take good care of you.
Blair
