Hormones, Immunity & Midlife: How to Stay Strong Through Perimenopause

Dr. Rachel Winstedt, ND
Sep 17, 2025
4 min read

Introduction

Perimenopause is more than just hot flashes and irregular periods. It’s that 5-to-7 year stretch of life before your periods completely stop and it’s when your immune system-- also starts to change. Many women notice that they get sick more easily, take longer to recover, or feel inflamed and run-down. This article breaks down what’s really happening to your immune system during perimenopause and offers practical, natural ways to feel strong and resilient again.

What’s Happening to Your Hormones — and Why It Affects Immunity

The Drop in Estrogen and Progesterone

During perimenopause, estrogen and progesterone levels start to fluctuate and gradually drop. These hormones aren’t just about periods and fertility — they also help keep your immune system balanced and inflammation under control. When levels decline, your immune system can become more reactive, leading to more aches, pains, and even flare-ups of autoimmune conditions like thyroid disease or joint pain.

Your Immune System Is Aging, Too

Around this time, your immune system naturally slows down (a process called immunosenescence). This means fewer fresh immune cells are being made, making it harder to fight infections and keep inflammation in check.

Signs That Perimenopause Is Affecting Your Immune System

You might notice:

More colds and infections than you used to get.
Slower recovery from illness or injury.
New or worsening allergies or autoimmune symptoms.
Feeling inflamed — joint stiffness, puffiness, brain fog.
Changes in energy and mood that go beyond stress or lack of sleep.

Why Inflammation Increases

When estrogen levels drop, your body makes more of certain chemical messengers called cytokines that turn on inflammation. A little inflammation is good for healing — but too much, for too long, can contribute to heart disease, weight gain around the belly, and brain fog.

How Gut Health, Sleep, and Stress Play a Role

Your gut microbiome (the trillions of bacteria living in your digestive tract) helps train and regulate your immune system. Hormonal shifts can throw off gut balance, leading to bloating, food sensitivities, or more inflammation.

Poor sleep and high stress — both common in perimenopause — also suppress healthy immune function, making the problem worse.

Your Action Plan to Stay Healthy

1. Eat to Support Your Immune System

Load up on colorful veggies and fruits (especially leafy greens and berries).
Get plenty of protein to keep muscles strong and support healing.
Add healthy fats like avocado, olive oil, nuts, and omega-3-rich fish.
Cut back on processed foods and sugar, which can fuel inflammation.

Simple, seasonal, colorful foods are a must!

2. Move Your Body

Aim for a mix of gentle cardio, strength training, and stretching. Exercise helps immune cells circulate, reduces stress, and keeps weight and blood sugar in balance. Aim for at least 150 minutes of moderate aerobic activity per week + strength training.

3. Prioritize Sleep

Create a bedtime routine — dim the lights, keep your bedroom cool, and skip screens an hour before bed. Maintain a consistent sleep schedule, optimize sleep environment (cool, dark, quiet). Address night sweats, hot flushes that interrupt sleep—cooling mattress, breathable sleepwear, avoiding trigger foods. Good sleep resets your immune system every night.

4. Manage Stress

Practice deep breathing, mindfulness, yoga, or simply go for a walk. Reducing stress lowers cortisol (your stress hormone), which otherwise can weaken immunity.

5. Support Gut Health

Eat fermented foods like yogurt, kefir, or sauerkraut. Aim for fiber-rich meals to nourish healthy gut bacteria. Limit factors that impair gut barrier (e.g., excessive alcohol, certain medications).

6. Maintain Healthy Weight & Metabolism

Because insulin resistance often increases, focus on maintaining lean body mass, avoiding visceral fat accumulation. Regular physical activity, balanced diet, possible intermittent fasting or time-restricted eating under guidance.

7. Consider Professional Support

Menopause-trained providers like me, can check your hormones, inflammation markers, and nutrient levels. For some women, hormone therapy or targeted supplements (like vitamin D, omega-3s, zinc, select botanicals) can make a big difference.

Medical and Hormonal Interventions

1. Menopausal Hormone Therapy (MHT)

Evidence shows MHT can partially reverse pro-inflammatory markers, restore certain immune parameters.
Route matters: oral vs transdermal have different effects. Transdermal may avoid first-pass hepatic metabolism and confer fewer adverse impacts on inflammatory proteins.
Must be tailored: risks vs benefits, individual factors (age, symptoms, comorbidities).

2. Nutrient Supplementation (as appropriate and under medical supervision)

Vitamin D: supports immune regulation, lowers pro-inflammatory cytokines.
Omega-3 supplements (EPA/DHA) (if dietary intake insufficient).
Trace minerals like zinc, selenium which support immune cell function.
Possibly botanicals or phytoestrogens, with caution and against interactions.

3. Monitoring & Lab Tests

ANA autoimmune panels and Cytokine panels (IL-6, TNF-α, CRP) in some settings.
Hormone levels: Estradiol, progesterone, possibly DHEA and Testosterone.

When to Seek Help:

See your provider if you notice:

Frequent infections (respiratory, urinary) or illnesses that linger.
Unexplained fatigue, malaise, delayed recovery from colds or other infections.
Symptoms of autoimmune disease: joint pain/swelling, rashes, unexplained weight changes.
Persistent high inflammation markers, metabolic shifts (e.g. worsening insulin resistance).
Any symptoms severely impacting quality of life—professional evaluation is necessary.

Putting It All Together: A Holistic Immune Support Plan

The following plan, combines daily, weekly, and periodic actions:

Time-Frame	Action
Daily	Balanced meals (anti-inflammatory), hydration, moderate movement, sleep hygiene, stress management.
Weekly	Two strength training sessions, multiple moderate aerobic sessions, mindfulness/yoga.
Monthly	Review dietary adequacy (micronutrients), track symptoms (sleep, mood, immune), adjust habits.
Quarterly	Lab check (hormones, & inflammatory markers if appropriate), evaluate need for supplementation &/or medical therapies.
Yearly	Comprehensive evaluation: bone density, cardiovascular risk, autoimmune screening if family or personal history indicate.