Everyone’s perimenopause and menopause journey looks a little bit different, as no two bodies are the same. This is a case study of someone who completed The Starkel Nutrition Programs Peri + Menopause Program, co-led by functional medicine nutritionist Julie Starkel and naturopathic physician Dr. Lea McKinstry, and went on to work individually with Dr. McKinstry on her hormones. The unique program educates participants on diet and lifestyle opportunities, how to navigate the typical and not-so-typical symptoms, and uses specialized lab testing to pinpoint exactly which biomarkers need support. Because of this deep-diving approach and personalization, we have many success stories from previous participants. Let’s look at one now.

Patient Background

Jane was a 47-year-old woman who was experiencing irregular menstrual cycles, mood swings, hot flashes, and sleep disturbances over the previous year. She was interested in exploring natural medicine for managing her perimenopausal symptoms.

Medical History

Jane had a generally healthy lifestyle, practiced regular exercise, and maintained a balanced diet. She had no significant medical history but had a family history of osteoporosis.

Initial Assessment

Dr. McKinstry did a thorough examination and hormonal profile test to assess perimenopause. The results indicate steeply declining estrogen and progesterone levels, contributing to Jane’s symptoms.

Treatment Plan

  • First, Jane completed the 8-week Peri+Menopause Program offered by Starkel Nutrition Programs. In this extensive and thorough program, Jane’s organic acids test identified some nutrient imbalances and some room for dietary improvements. She started to enhance her already healthy diet, adding phytoestrogens, such as soy and flaxseeds, to help balance hormone levels. She also emphasized the importance of minerals, fatty acids, and a few additional vitamins for bone health.
  • In addition to balancing basic nutrients, she added on a hormone test and found that she could benefit from some herbal supplements known for their estrogenic properties and balancing hormones. These supplements helped her greatly reduce hot flashes and mood swings.
  • Jane also learned that stress was a huge driver of her symptoms, so she started to incorporate and practice stress-reduction techniques like deep breathing, yoga and meditation to manage mood swings. Regular exercise and muscle training were also encouraged to support her overall well-being.
  • Given the severity of Jane’s symptoms, she and Dr McKinstry discussed the option of BHRT (Bio-identical Hormone Replacement Therapy). This form of hormone replacement therapy uses hormones that are structurally identical to those produced by the body. They are tailored to address the specific hormonal imbalances detected in Jane’s bloodwork. Jane started on her made-to-order compounded bio-identical hormones. Compounding allows Dr. McKinstry to give her patients the appropriate doses of hormones without resorting to one-size-fits all levels that just do not work for everyone.
  • Regular follow-ups were scheduled to monitor Jane’s progress. Adjustments to the herbal supplements and BHRT dosage will continue to change based on Jane’s response and any changes in her symptoms.


Over the next few months, Jane experienced significant improvement in her symptoms. Her menstrual cycle became more regular, and the intensity and frequency of hot flashes decreased dramatically. She continues to report better sleep quality and mood stability.


The combination of natural medicine, including herbal supplements, nutritional testing and supplementation, movement and exercise, stress management, and lifestyle modifications, along with targeted BHRT, proved effective in managing Jane’s perimenopausal symptoms. This personalized approach emphasizes a holistic perspective, addressing both the physiological and psychological aspects of perimenopause. 

We were so happy to help Jane through this transition and will continue to work with her as she continues into menopause. Our patients rave about their results. Thank you Jane!

Does Jane’s story resonate with you? If so, check out the Starkel Nutrition Peri + Menopause Program, next session begins January 9, 2024! We hope to see you there.

Interested in learning more? Schedule an appointment with us to get support on your journey to holistic and kind health.

Written by Dr. Lea McKinstry, ND