Free step-by-step toolkit · MK Wellness
Perimenopause Toolkit
A calm, step-by-step plan for the hormone years: what’s happening, the tests and options worth knowing, and daily habits that help you feel like yourself again.
Take a breath. You don't have to do this all at once. Pick where you are below, and start with one step today.
A note from Dani
This is a transition, not a disease, and you deserve to feel good through it.
Perimenopause can turn your body upside down: hot flashes, broken sleep, weight that won’t budge, mood swings, and brain fog, often while you’re caring for everyone else. So many women are told it’s "just age." It’s not just anything. It’s a real hormonal shift, and there is a lot you can do about it.
This toolkit brings together the best of what we’ve learned from menopause specialists, functional medicine, researchers, and the women we see every week. You’ll find hormone and non-hormone options side by side, with honest labels on the research, so you can choose your path with your eyes open.
How to use this toolkit
- Tell us where you are (just below) to see your first six steps.
- Tick each box as you go. Your checkmarks save on this phone or computer, so you can come back anytime.
- Bring your questions to appointments: print them, or email them to yourself. Talk through anything new with your doctor before you start it.
Where to start
Noticing changes
- Track your symptoms for a month or two (step 1)
- Ask for a full thyroid panel: TSH, free T4, free T3, and thyroid antibodies (step 3)
- Ask about iron: ferritin and a complete blood count, especially if your periods are heavy (step 3)
- Ask about blood sugar and insulin: fasting glucose, fasting insulin, and HbA1c (step 3)
- Or a menopause-trained practitioner (step 4)
- Lead every meal with protein (step 7)
In the thick of it
- "Am I a candidate for hormone therapy? What are my personal benefits and risks?" (step 4)
- Try CBT for menopause (step 6)
- Find your triggers (step 6)
- Protect your sleep (step 9)
- Strength train 2 to 3 days a week (step 8)
- Book a free tour or a first visit (step 12)
After menopause
- Ask about a bone density scan (DEXA) (step 10)
- Know your heart numbers (step 10)
- Add impact as your body allows (step 8)
- Use a vaginal moisturizer (step 11)
- Watch the trend, not one number (step 3)
- Find your people (step 9)
What the research labels mean
- Strong National guidelines recommend it, based on many trials.
- Promising Positive randomized or controlled human trials; still being confirmed.
- Emerging Early human data: small studies, case series, clinic data.
- Experimental Lab and animal studies plus personal stories; human trials still needed.
The 13 steps
Perimenopause usually starts in your 40s and lasts about 4 years on average, though for some women it’s much longer. Estrogen and progesterone rise and fall unpredictably, which is why symptoms can come and go. Menopause itself is one day: 12 months in a row without a period, around age 51 on average.
Common signs
- Periods that change: closer together, further apart, heavier, or lighter
- Hot flashes and night sweats
- Trouble falling or staying asleep
- Mood swings, anxiety, irritability, or low mood
- Brain fog and forgetfulness
- Weight gain, especially around the middle
- Joint aches, dry skin, and thinning hair
- Vaginal dryness, lower desire, or bladder changes
Call your doctor if you have
very heavy bleeding, bleeding that lasts much longer than usual, bleeding between periods or after sex, or any bleeding after 12 months without a period. If you feel hopeless or think about harming yourself, call or text 988, any time.
There’s no single test for perimenopause. Because hormones swing day to day, one FSH or estrogen result can’t confirm it; for women over 45, symptoms and age usually tell the story. Labs help rule out look-alikes and show where your body needs support.
Who What they do How to find one Functional medicine practitioner Looks at the whole picture: hormones, thyroid, blood sugar, gut, stress, and sleep IFM Find a Practitioner or the Natural Health Network directory (MK Wellness is a member) Telehealth hormone evaluation Licensed providers who evaluate you for hormone therapy or weight-loss options We refer to EllieMD, a telehealth platform. That care happens through EllieMD directly, not at MK. Certified menopause practitioner (MSCP) Doctors and nurse practitioners trained in menopause care, including hormone and non-hormone options The Menopause Society’s directory Pelvic floor physical therapist Bladder leaks, pelvic pain, and pain with sex Ask your gynecologist for a referral Counselor or therapist Mood, anxiety, and the big life changes that often come at this age Your doctor, your insurance plan, or Psychology Today’s directory Supportive wellness, like MK Recovery, body composition, sleep, and calm MK Wellness, Cypress: (346) 805-8928 Questions for your doctor
There’s no single right answer. Start with the foundations in this toolkit, food, muscle, sleep, and calm, which help with almost everything. Many women also feel best with bioidentical hormones, guided by a functional or integrative practitioner who listens. Read our guide to bioidentical hormones.
Bioidentical hormones
StrongThe strongest help for hot flashes and night sweats, and they help protect bone. Bioidentical estradiol and progesterone match your body’s own, and a compounding pharmacy can custom-make the dose and form your practitioner prescribes. The Menopause Society says that for healthy women under 60, or within 10 years of menopause, the benefits usually outweigh the risks. In November 2025, the FDA removed most of the "black box" warnings from hormone therapy labels (FDA).
Good to know: Ask your practitioner about both routes: standard bioidentical estradiol (patch, gel, or pill) and micronized progesterone, or custom-compounded. Compounded hormones aren’t FDA-approved, so choose a PCAB-accredited compounding pharmacy and ask how it tests each batch. Women with a uterus need progesterone with estrogen.
Vaginal estrogen and moisturizers
StrongDryness, pain with sex, and bladder urgency are common and very treatable. Low-dose vaginal estrogen works locally, and vaginal moisturizers and lubricants help too.
Good to know: Ask your doctor; this is one of the most under-asked questions in menopause care.
Testosterone for low desire
PromisingAn international position statement supports testosterone for postmenopausal women whose low sexual desire bothers them. It isn’t FDA-approved for women in the US, so it’s prescribed off-label.
Good to know: Ask a menopause practitioner about monitoring if you explore it.
Non-hormone prescriptions
StrongNewer prescriptions calm the brain’s temperature center without hormones, and a few other medicines also ease hot flashes. Ask your doctor if you want them.
Good to know: Ask about side effects and any monitoring they need.
Start with what you can do today: find your triggers, keep cool, and calm your nervous system. Mind-body tools like clinical hypnosis and CBT have strong research behind them, and hormones are the strongest option if you want them. Movement, yoga, and real food may not stop hot flashes on their own, but they’re the foundation for sleep, mood, weight, bones, and heart.
Bone loss speeds up in the years around menopause. In the LIFTMOR trial, postmenopausal women with low bone mass who did supervised high-intensity strength and impact training improved their bone density (Journal of Bone and Mineral Research, 2018).
In the long-running SWAN study, women were 30% to 70% more likely to have depressive symptoms during perimenopause than before it. You’re not imagining it, and you don’t have to push through alone.
Heart disease risk rises after menopause (American Heart Association, 2020), and bone loss speeds up. The good news: strength, steady blood sugar, sleep, and knowing your numbers protect both.
MK Wellness is a non-medical wellness spa, and a lot of our clients are women in this exact season. We build protocols around your goals; our perimenopause protocols article has the full details and a sample week.
Your goal What we suggest Stubborn weight Strength training plus EMS Body Contouring, mild hyperbaric oxygen or HOCATT, the lymphatic roller and compression boots, and a 3D body scan to track muscle and inches Hot flashes The Cryo Float for cool relief; shorter infrared sauna sessions with a cool-down; PEMF and the Sound Lounge to calm the nervous system Sleep, mood, and brain fog The Sound Lounge, PEMF, and spinal thermal massage in the evening; red light earlier in the day Skin, joints, and bones Red light for skin, PEMF for joints, the vibration plate for bone loading, and pelvic floor strengthening Good to know
Heat affects women differently in this stage. Some find the sauna triggers hot flashes, and others love it. Start with shorter sessions and cool down with the Cryo Float.
Who Helps with Contact IFM Find a Practitioner Functional medicine practitioners near you ifm.org/find-a-practitioner Natural Health Network Holistic practitioners near you naturalhealthnetwork.org Let’s Talk Menopause Free, plain-language education letstalkmenopause.org The Menopause Society Finding a certified menopause practitioner, and patient information menopause.org Office on Women’s Health Menopause basics from the US government womenshealth.gov/menopause 988 Suicide & Crisis Lifeline Free, confidential support, any time Call or text 988 Dr. Mindy Pelz, DC
Two-time New York Times bestselling author
In Fast Like a Girl and The Menopause Reset, she teaches women to time fasting and food around their hormones, and to “work with their biology, not against it.”
Dr. Gabrielle Lyon
Founder of Muscle Centric Medicine
In Forever Strong, she makes the case for muscle and protein as the foundation of aging well: “We are meant to be strong. Strength is not a luxury but a responsibility.”
Dr. Lara Briden, ND
Naturopathic doctor
In Hormone Repair Manual, she explains that early perimenopause symptoms often come from falling progesterone, and treats this stage as a tipping point for long-term bone, heart, and brain health.
Dr. Mary Claire Haver, MD
OB-GYN
Author of The New Menopause. She helped bring updated hormone therapy research, and practical nutrition for midlife women, to millions.
Dr. Lisa Mosconi, PhD
Neuroscientist, Weill Cornell Medicine
Author of The Menopause Brain, on why brain fog, sleep, and mood change in this stage, and what supports the brain through it.
Dr. Stacy Sims, PhD
Exercise physiologist
Author of Next Level, on training and fueling through menopause: lift heavy, add impact, and eat enough protein.
Dr. Felice Gersh, MD
OB-GYN and integrative physician
Author of Menopause: 50 Things You Need to Know. She teaches how estrogen keeps the body’s clock, metabolism, and gut in sync.
Dr. Sara Szal (Gottfried), MD
Physician and author
Author of Women, Food, and Hormones, on how hormones and metabolism work together.
Dr. Eric Berg, DC
Nutrition educator
Known for his teaching on keto and intermittent fasting. His free Postmenopausal Muscle Loss Recovery Guide rebuilds strength in three parts: protein, key nutrients, and lifting that builds up safely. Read our summary.
Read more about these experts in five physicians reshaping women’s hormone care, and explore our Hormone Health guide.
We're in your corner.
Questions about this toolkit, or want help building your MK protocol? Call or text us. We're happy to talk it through.
MK Wellness · 17844 Mound Road, Suite F, Cypress, TX 77433 · Call or text (346) 805-8928 · mkwellness.care/toolkits/perimenopause
Important. MK Wellness provides wellness services for comfort and quality of life. We do not diagnose, treat, or cure any condition. This toolkit is educational, shares information about options at different stages of research, and does not replace advice from your doctors. It deliberately includes no doses or protocols. EllieMD is a separate telehealth company; any evaluation or prescription happens through EllieMD directly, and MK Wellness may earn a referral fee. Mention of a person, book, or program is not an endorsement of every claim they make. Resource details can change; confirm with each program.