How To Work With Middle Perimenopause (Ages 45ish-48ish)

What is Middle Perimenopause (PM)?

It’s when your symptoms begin to uptick.

✅ You start to wonder who you are and what the hell is going on with your body.

✅ You have more anovulatory cycles, meaning even less progesterone. And your estrogen can be high one month, and low the next.

✅ You are around age 45, but could be 43 or 44.

 It’s go time.

Again, as I did with beginning PM (go back and read Perimenopause: What It Means And What’s Happening To You, Best Practices For Early Perimenopause, and My Top 5 Rules for Perimenopause if you missed them), I will be recommending behavorial, dietary changes, and supplements to help you through this transition. 

Behavioral changes:

This is the time to really, TRULY start to deal with your emotional life, if you haven’t already.

✨ If you aren’t in therapy, go ahead and find a therapist (I’ll wait).

Start using EFT on your own, immediately (I have some videos on my YouTube channel, and there are plenty of others there too).

Because middle PM wants you to define who you are *for yourself* as you embark on the second half of your life. 👉🏼 Not who you are for your partner. Or your job. Or your kids. Or whatever box the world wants to fit you in.

✨ Old traumas WILL rise to the surface if you haven’t faced them. Your body will no longer let you push them down and carry-on.

✨ Support this transition with lots of sleep.

If your sleep is off (and it most likely will be), do whatever it takes to make it better.

 👉No technology past 9pm

👉Blue-blocking glasses

👉Wind-down yoga or meditation starting no later than 9pm

👉In bed with lights off, eye-cover on, ear plugs in by 10pm

👉Test cortisol and melatonin levels if you can. It’s best not to take melatonin unless you know it’s low. Phosphorylated serine can be a game changer. Magnesium, Taurine, L-Theanine are also good options. Often, you have to combine a couple to find your perfect cocktail to reignite a good sleep pattern.

 Remember, your body is going through reverse puberty. It needs extra sleep at a time it is most sensitive to sleep troubles.

And because of our circadian rhythm, the 90 minutes phase before midnight is THE MOST POWERFUL and rejuvenating of the entire night (some say that one hour of sleep before midnight is equivalent to 2 hours after midnight). 

✨✨Challenge time✨✨ No matter where you are in PM, I challenge you next Monday-Friday to be in bed, without any technology on, and lights off, by 10pm. See how you feel after 5 days of doing this one thing!

Honing in Your Diet

As I already mentioned, middle PM is a time of reckoning. Where are you in your life? Where do you want to be? WHO do you want to be in the second half of your life?

Really zeroing in on your diet here, if you haven’t already, is gonna make a lot of difference.

➡️ Keeping your blood sugar regulated is 🔑 KEY 🔑. Your body simply cannot handle carbs the way it used to. As estrogen starts to get wonkier, dipping up and down, your ability to optimize insulin reduces. So you have to pick up the slack.

➡️ The RDA for protein a day is .8g per pound of your weight. Most functional medicine experts agree that is too low, and recommend 1g of protein per pound.

➡️ Yes, that means if you are 160 pounds, you should be getting 160g of protein per day.

Now, I know that’s a lot for a lot of women, so I recommend starting at 80g per day and working your way up slowly from there. If you track your protein, I bet you aren’t getting 80g a day right now.

If you eat 3 meals a day, that means you should be shooting for around 27g of protein per meal.

It’s amazing the symptoms that diminish for women when they start to get more protein. You start to naturally decrease the foods that are feeding insulin resistance.

Something that can very useful during this time is to learn whether your body is burning fat or carbs. I personally use the Lumen device to track this, as it’s a very simple, non-invasive way to track your metabolism throughout the day, and point you to which foods are better for your body. You can get $50 off with code “CHRISTINEG” at checkout.

Though whole, real foods are always best, it can be hard to get that amount in every day. So on the days that it’s tough to make that happen, I turn to collagen powder.

Collagen powder has many benefits other than just providing protein:

✨ Collagen powder is easily digested, meaning it doesn’t take much work for your stomach to get to the amino acids that make up the powder.

✨ And while a lot of people think that eating collagen=collagen production in your body, it doesn’t quite work that way.

✨ Amino acids are needed for innumerable processes in your body **including liver detox that moves estrogen out of your body**, so your body will use them where needed.

✨ But the more protein we get, the more amino acids the body will have to help your hair, skin, and nails.

✨ It’s also SUPER helpful for healing the gut lining, which most of us can use some help on.

I’m always working on more deeply healing gut lining after multiple colon surgeries, so if you fall into that category, bring some collagen powder in!

Add collagen to coffee, tea, smoothies, (GF) baked goods. One scoop contains 9-10g of protein, depending on the brand. I personally use Neocell (which you can purchase through my Fullscript dispensary for 10% off), as the Organic Consumers Association found it to be one of the brands with the lowest heavy metals.

Let me know if you use collagen powder and if it’s made a difference for you!

What about intermittent fasting? I know this is controversial to say, but for most women during this phase of life, it’s not a great idea to go beyond 12-13 hours of not eating.

This is a whole other post for another day, but I generally recommend waiting until menopause to go for those shorter eating windows. I’ve seen way too many clients’ hormone labs whose estrogen bottomed-out during this phase because of IF.

Supplements & Nutrients

Before I dive into which supplements are the most supportive during this phase, let me remind you of something:


So if you missed my previous posts on middle perimenopause, go back and read those first.

Okay, what supplements help most during this time?

Honestly, this is where I’m gonna tell you to get a regular blood lab (and possibly HTMA) done and evaluated by a functional medicine practitioner.

Because your deficiencies are your own.

Your thyroid maybe/probably is somewhat out of whack. Depending on what those thyroid numbers look like, you may need iodine, or selenium, or zinc. But you don’t want to take iodine if you have elevated thyroid antibodies.

(So test!)

I often find women in this phase are low in:


👉Vitamin D

👉B vitamins, particularly B6, B12, and Folate


You can see all of these on blood labs (though this is not the best way to test Magnesium).

As I like to call “mucked-up livers” are usually happening big time by now, so if you can take a Dutch hormone test and see how Phase 1 and Phase 2 detox are doing, you’re gonna get ahead of the curve.

The Dutch also provides a mini-OATs test, which will tell you levels of glutathione and neurotransmitters, helpful for how your body is detoxing, as well as what’s happening with your mood.

Finally, adrenals are usually in need of some heavier-duty support with adaptogens and for high cortisol, phosphorylated serine.

Remember, upping YOUR missing nutrients is key to leveling out hormonal imbalances.

There’s a lot you can (and need to do) via diet, but looking at your specific deficiencies is going to get you a whole lot further along faster than throwing random supplements that you read about online at the problem.

Lifestyle Change is Key

How we take care of ourselves during middle PM makes all the difference in how we feel (and how the rest of this journey is gonna go).

Lifestyle is a biggie, y’all. Adrenals are overworking it; our cortisol is either too high, too low, or a combination of the two (I see this on hormone testing all the time).

This impacts our progesterone, estrogen, and testosterone more than most of us can imagine.


You gotta change your lifestyle. Let me repeat: YOU GOTTA CHANGE YOUR LIFESTYLE.

The upshot? You’re not only gonna feel better, but you are going to enjoy life more.

The wheel pictured explains some options of where to start:

✨Psychological: Be creative, meditate, keep a journal

✨Emotional: EFT (Emotional Freedom Technique), AIT (Advanced Integrative Technique), Therapy (any form that works for you!)

✨Personal: Set boundaries (the BIGGEST and most important thing you can learn to do!), gain clarity around what you want

✨Movement: for low cortisol, do yoga or Pilates; high cortisol, lift weights

✨Professional: learn how to say no, do you feel passion for your work?

✨Spiritual: Connection to Universe/Your form of Goddess or God

These are just starting points. In my group program, Hormone Breakthrough Blueprint, we dive deep into the emotional, spiritual, and lifestyle changes to make during this beautiful life transition.

Now that we’ve talked middle perimenopause, if you are further along in the process or want to get ahead of the game, you can learn more about the last stage of PM in Late Perimenopause.

What's Your Hormone Issue? Take this 2-minute quiz to find out!


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