What To Do Before (Or Alongside) HRT

Before fully realising what is happening in their bodies, women going through perimenopause tend to feel very unlike themselves. For some, it starts with disrupted sleep or anxiety that comes out of nowhere. Others notice brain fog, low mood, stubborn weight changes, or a sudden drop in energy that no amount of coffee seems to touch. 

“Hot flashes and irregular mood tend to get the most attention first, partly because they’re some of the most visible and disruptive symptoms,” says Cathy Eason, chief science officer at Berkeley Life. “But what’s far more commonly overlooked are the subtler, slower-burn symptoms: brain fog, low mood, increased anxiety, joint aches, and a general sense of feeling ‘off’ that women often attribute to stress or getting older.” Hormone imbalances certainly play a central role here, but they rarely explain everything women are experiencing. 

Hormone replacement therapy, which involves medically replacing or supplementing hormones like oestrogen, progestogen, and even testosterone that decline around perimenopause and menopause, can be transformative for many women. However, you should always consult a medical professional before starting HRT, and those with a history of breast cancer or hormone-sensitive cancers, blood clots, cardiovascular conditions, or severe liver disease are not good candidates.

While HRT can be life-changing, experts are clear that factors like sleep, muscle mass, blood sugar, nutrition, stress and cardiovascular health also significantly influence energy, mood, recovery and day-to-day symptoms during this stage of life. And as such, there are some practical things to get in place before starting HRT, or to do alongside it, that can make a noticeable difference during this life stage.

Why hormones are only part of the story

It’s tempting to think perimenopause and menopause are purely about falling oestrogen, but these hormonal changes have widespread impacts on your entire system. Remember that hormones are the body’s chemical messengers, which means that when they’re not operating at full capacity, your biological systems and organs don’t always get the information and key signals they rely on to function.

“Hormones set the stage, but they’re not the whole story,” says Eason. “Blood sugar regulation has an enormous influence. Fluctuating estrogen makes insulin sensitivity less stable, which can drive energy crashes, mood swings and cravings. Sleep quality becomes both a symptom and a driver. Poor sleep worsens virtually every other symptom.”

Heart health is another area that doesn’t get nearly enough attention in conversations about menopause. “Oestrogen has a profoundly protective effect on the heart and blood vessels,” says Eason. “As estrogen declines, that protection diminishes. Blood pressure can begin to rise, LDL cholesterol often increases and arterial stiffness accelerates.”

Critically, she says oestrogen also supports the body’s ability to produce nitric oxide, the molecule that signals blood vessels to relax and dilate, helping maintain healthy blood flow, blood pressure and circulation. As nitric oxide production declines, some women notice changes that feel surprisingly physical, like reduced exercise tolerance, breathlessness, palpitations or simply not feeling as resilient as they once did.

“Heart palpitations in particular are a frequently reported symptom that catches women off guard,” says Eason.

6 habits experts focus on before starting (or alongside) HRT

For women deciding whether HRT is right for them, Eason says it’s worth establishing lifestyle support right off the bat because it supports things hormone treatment alone won’t fix. “For women who are earlier in perimenopause and not yet sure whether they want or need HRT, lifestyle and nutritional foundations are genuinely powerful and worth establishing first,” she says. “For women who do choose HRT, the evidence suggests it works better and feels better in a body that’s well-nourished, [and those who are] regularly exercising and not running on chronic stress.”

That way, you can reap the most benefits from your treatment, and get back to feeling like yourself.

Here are the areas experts tend to focus on first:

1. Strength train at least twice a week

If there’s one habit Eason would prioritise, it’s this. “Strength training is probably the single most impactful habit,” she says. “It supports bone density, muscle mass, insulin sensitivity, mood and metabolic health all at once.”

This becomes particularly important during perimenopause and menopause because declining oestrogen makes it easier to lose muscle and harder to maintain metabolic health. You don’t need an intimidating gym routine to hit this metric. Two to three sessions a week of resistance training per week, whether that’s weights, Pilates, resistance bands or bodyweight work, is a strong place to start.

2. Stop blood sugar crashes hijacking the day

One of the quickest ways to feel worse during perimenopause is to ride an energy rollercoaster. “Fluctuating estrogen makes insulin sensitivity less stable,” says Eason. “This can drive energy crashes, mood swings and cravings.” 

If your day looks like coffee, toast, suddenly starving by 11am, a sugary snack, then a crash again by mid-afternoon, your blood sugar may be playing a bigger role than you think.

Eason recommends focusing on meals that keep energy steadier across the day. That usually means not relying on coffee and carbs alone, eating regularly, and combining fibre, healthy fats, and protein so meals actually keep you going. Think eggs or Greek yoghurt at breakfast instead of toast alone, adding something substantial to lunch, and avoiding the 4pm crash-and-snack cycle.

You don’t need to cut out carbs or eat “perfectly”. Often, a few small changes are enough to make energy, cravings, and mood feel far less chaotic.

3. Focus on protein

Protein becomes even more important as hormones change, especially when it comes to supporting muscle mass, energy, and appetite. As oestrogen declines, it becomes harder to maintain muscle, which is one reason protein at this stage matters a lot more than it used to. “Prioritising protein at every meal works hand in hand with strength training,” says Eason. 

Yet, many women are simply not eating enough of it, especially earlier in the day. As a rough guide, aim for a proper serving at each meal. Eggs, fish, tofu, Greek yoghurt, chicken, beans, lentils, or quality protein powders can all help. If breakfast is mostly carbs and lunch leaves you hunting for snacks by 3pm, protein is usually one of the first things worth increasing. 

Leafy greens and beetroot are also useful additions here. Eason says they are naturally rich in dietary nitrates, which help boost nitric oxide production through a pathway that remains active even as estrogen-driven production declines.

4. Get stricter with sleep

Sleep disruption becomes incredibly common during perimenopause, whether you’re experiencing night sweats, anxiety, hormone changes, or suddenly waking at 3am for no obvious reason. “Sleep quality becomes both a symptom and a driver,” says Eason. “Poor sleep worsens virtually every other symptom.”

Her advice is surprisingly straightforward:

• Wake up and go to bed at roughly the same time most days
• Keep the bedroom cool, especially if night sweats are an issue
• Pull back on alcohol in the evening, which can worsen disrupted sleep
• Get outside early in the day, as natural light supports circadian rhythm and melatonin production

We’re not saying you need to bank perfect sleep scores every night. It’s more about helping you have fewer disrupted nights of sleep.

5. Don’t ignore your cardiovascular health

One of the biggest changes happening during menopause is one women tend to know the least about. “As estrogen declines, nitric oxide production also declines,” says Eason. “This is a significant mechanism behind many of the vascular changes that happen during menopause, from rising blood pressure to reduced circulation and exercise tolerance.”

Heart health can affect how women feel long before it shows up in a health check. Because these changes often happen gradually, they can be easy to dismiss as “just getting older” rather than hormonal disruptions. It is one reason Eason says menopause support needs to go beyond hot flushes and mood changes alone.

6. Find stress support you’ll actually stick to

Stress has always affected hormones, but perimenopause can make the connection much harder to ignore. “Cortisol and adrenal function are significant, especially for women who’ve been running on stress for years,” says Eason.

High stress can worsen sleep, anxiety, fatigue, and nervous system symptoms, leaving women feeling increasingly depleted. “Stress management isn’t optional at this stage,” says Eason. However, ‘managing stress’ is a lot easier said than done. “Practices that genuinely regulate the nervous system, whether that’s breathwork, walking, meditation or simply downtime, have a measurable effect on symptom burden,” Eason adds. The best approach is usually the one you’ll repeat. Ten minutes of walking every day beats an ambitious breathwork and mindfulness routine you abandon after one week.

Why fatigue feels different during perimenopause

“The fatigue of perimenopause and menopause is genuinely different from regular tiredness, and it has multiple overlapping causes,” says Eason. Disrupted sleep is one piece of it, but hormones also affect neurotransmitters linked to mood, calm, and sleep quality. Blood sugar instability can create energy highs followed by dramatic crashes. Years of chronic stress can also leave women feeling as though their system has less resilience than it once did.

Even women without obvious menopausal symptoms may notice they’re sleeping less deeply or waking more often through the night because hormonal changes affect melatonin and cortisol rhythms too. “Supporting fatigue means addressing all of these layers: sleep quality, blood sugar balance, nutrient repletion and stress load,” says Eason.

Where supplements fit in

Supplements can help in certain circumstances, but Eason says the strongest options tend to support more than one area at once. “For perimenopause and menopause specifically, the most useful products are those that address multiple connected needs rather than a single symptom in isolation,” she says.

That’s partly because symptoms have a habit of arriving together. Poor sleep, energy dips, mood changes, hot flushes, and cardiovascular changes often overlap. For women who are not ready for HRT, or those who’d rather not take it, non-hormonal support can be useful, especially when paired with lifestyle support.

Eason points to Berkeley Life’s Menopause and Heart Health Support as one example of a supplement designed to support several areas at once. The formula combines a clinically studied pollen complex aimed at hot flushes, night sweats, and mood symptoms, with beetroot-derived nitrate support intended to support nitric oxide production and vascular function. For women interested in tracking progress, Berkeley Life’s Nitric Oxide Test can also be used to monitor how effectively the body is converting dietary nitrates into nitric oxide. 

If you are going to supplement to help support your body through menopause, choose products with transparent ingredients, clinical backing, and a clear reason for being there, rather than throwing ten different nutrients at the problem and hoping for the best.

So, should lifestyle come before HRT?

For many women, it’s not an either/or situation. If you are earlier in perimenopause and not yet sure whether HRT feels right, getting a few key lifestyle foundations in place can be genuinely useful. If you do decide to take HRT, those same habits still count and can support your journey.

“For women who are earlier in perimenopause and not yet sure whether they want or need HRT, lifestyle and nutritional foundations are genuinely powerful and worth establishing first,” says Eason. “For women who do choose HRT, it works better in a body that’s well nourished, regularly exercising and not running on chronic stress.”

HRT can help replace hormones, but it doesn’t magically fix everything. It doesn’t automatically increase muscle mass, steady blood sugar, improve sleep habits, or reduce chronic stress on its own. For many women, the best support often comes from combining treatments with everyday habits that help them feel better rested, physically stronger, and more capable again. Better energy, fewer crashes, and steadier sleep are all reasonable things to aim for.

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