Holistic Perimenopause and Menopause Coaching: How I Approach It at Fabulous in Midlife
The word "holistic" has been used to sell a great deal of nonsense. Let's clear that up first.
Holistic perimenopause coaching, the way I work, means one thing: looking at everything that affects how you feel at the same time, instead of fixing one thing and hoping the rest follows. It doesn't mean crystals. It doesn't mean giving up everything you enjoy. And it certainly doesn't mean choosing between a menopause coach and your doctor.
I came to this work after a career in finance, which is possibly the least mystical background available. This post explains what I actually do, what I don't, and how to tell whether it would be useful to you.
What holistic actually means here
Holistic perimenopause and menopause coaching means treating you as one system rather than a list of separate complaints.
Your sleep affects your appetite. Your appetite affects your energy. Your energy decides whether you train. Whether you train affects your sleep. Round it goes.
What it doesn't mean:
- An alternative to medicine. It sits alongside it.
- Anti-HRT or pro-HRT. That decision is yours and your doctor's.
- A plan to eliminate everything you like eating.
- Evidence-free. If something has thin evidence behind it, I'll tell you.
Why fixing one thing at a time stops working
Most women arrive having already tried. They've cleaned up the diet, or downloaded the sleep app, or started the 6am spin classes.
Something usually improves for a while. Then it stalls, because the thing actually driving the problem was never touched.
The woman eating impeccably who still can't sleep. The woman sleeping better who's still gaining weight around her middle. The woman training hard who's exhausted rather than stronger. Each is doing something sensible in isolation, and isolation is the problem.
The five areas I work on
These are the five that make the most difference. Everything else is detail hanging off them.
1. Sleep
Usually first, because everything else is harder without it. Rather than handing you sleep hygiene tips you've already read, we dig into what's actually disrupting it — hormonal change, a reactive stress response, habits that stopped working — which is exactly the ground covered in why you can't sleep during perimenopause and menopause.
2. Nutrition and hydration
Not a diet, and not a list of forbidden foods. As I get into in what to eat during perimenopause and menopause, it's practical changes that support energy, body composition, gut health and hormones, with protein and fibre doing most of the heavy lifting — and hydration quietly affecting more than most women expect.
3. Movement
What worked in your thirties often stops delivering, and doing more of it usually makes things worse — a shift I unpack in exercise during perimenopause and menopause. Strength work takes priority: muscle loss comes with age, and this is the stage to protect what you have. Cardio and short high-intensity sessions have their place too, with proper recovery around them.
4. Stress regulation
Cortisol isn't the villain it's made out to be; you need it. The problem is dysregulation: a stress response that fires too easily and takes too long to settle.
This is where breathwork comes in — not as a separate area, but as the most direct tool I have for changing how reactive that system is, and it's the whole subject of breathwork for perimenopause and menopause. I'm certified in Buteyko, which carries most of my nervous system work, and in the Oxygen Advantage, a performance and recovery method I use with clients who want to keep training seriously through this stage. It's measurable, it's physiology, and it takes minutes a day.
5. Social connection
The one that gets left off every list, including most professional ones. Connection is usually the first thing to slip when you don't feel like yourself, and one of the most protective things to hold on to. If you've quietly stopped seeing people, that's not a side issue. It's part of the work.
How this sits alongside medical care
I'm not a doctor and I don't pretend otherwise. I don't diagnose, I don't prescribe, and I won't advise you for or against HRT.
What I will do is help you turn up to those appointments with specifics rather than a vague sense that something's off, and then do the work no ten-minute appointment has time for. Your GP, gynaecologist or endocrinologist handles the medical side. I handle everything that sits around it. The two work far better together than either does alone.
Why I work this way
I didn't arrive here through theory.
There was a stretch of real family difficulty in my life, and the effects showed up everywhere at once. I couldn't sleep. My mind wouldn't stop turning things over. And I had a run of symptoms that seemed entirely unrelated to each other — palpitations, a burning sensation in my mouth, ringing in my ears. I put all of it down to stress. It didn't occur to me that I was also in perimenopause, and that the two might be amplifying each other.
Sleep has always been my weakest link, and it stayed that way through perimenopause and menopause. Nothing shifted it until HRT — and even then it took time and adjustment. But HRT alone didn't do it either. What I eat, how I train, how I breathe and how well I manage stress all sit on top of that. Remove any one of them and my sleep tells me about it. It's still a work in progress. I'm not writing this from the far side of a solved problem.
Breathwork came in almost by accident. I had my CO2 tolerance tested and fell well short, which isn't what you want to hear. I went and investigated, as I do, and that led me to the Oxygen Advantage — initially just to improve my running. Once I started learning I realised how much more breathing affected, and trained in Buteyko as well.
That's why I work across all five areas rather than specialising in one. My own experience made it hard to believe in single-lever fixes.
What working together looks like
There's no single template, because no two women arrive with the same picture. Broadly:
- We start with a proper conversation about where you are — symptoms, history, lifestyle, what you've already tried and what happened.
- You get guidance across the areas that actually matter for you, not a generic plan with your name at the top.
- We adjust as things change, because they will.
- You have support between sessions, so you're not left implementing alone.
I work one to one and online, with women from their mid-thirties onwards — there's no upper age limit, and postmenopause isn't too late. I coach in English, Italian and Spanish.
It suits you if you want practical, evidence-based support and are prepared to make changes gradually. It's probably not for you if you want a meal plan emailed over with no conversation, if you're looking for advice on medication, or if what you actually need is therapy. In that last case I'll say so — and some women sensibly do both.
When to consider a menopause coach
Worth a conversation if:
- Your doctor has the medical side handled, and you still don't know what to do day to day.
- You're on HRT and feel better, but not as well as you'd hoped.
- You've fixed one thing and nothing else has followed.
- You know what you should be doing and can't make it stick.
- You've lost yourself somewhere in this and want practical help finding your way back.
For the fuller picture of the role itself rather than my version of it, what a perimenopause and menopause coach actually does covers it, and the menopause coach page sets out how to work with me.
The first step is a free consultation. It's a conversation, not a pitch — nobody sells you anything, and you're entirely free to decide it isn't for you.
What to do next
The first step is a free consultation — a conversation, not a pitch, and you're entirely free to decide it isn't for you.
Book your free consultation hereNot ready for that yet? There's a signup for occasional practical guides — a few times a year, when there's something useful to say.
Frequently asked questions
What does holistic perimenopause coaching actually mean?
Working on sleep, nutrition and hydration, movement, stress regulation and social connection together, because they affect one another. It doesn't mean alternative medicine, and it isn't a replacement for your doctor.
Do I have to give up coffee, wine and everything I enjoy?
No. An approach you resent is an approach you abandon by week three. We work out which changes give you the most benefit for the least misery, and start there.
Is this instead of HRT?
No. Coaching isn't an alternative to HRT and I won't advise you either way on it. Many of my clients are on HRT; some aren't. The lifestyle work matters in both cases.
Do I need to live near you?
No. All coaching is one to one and online, and I work in English, Italian and Spanish.
How long before I notice a difference?
It varies more than anyone selling you a programme will admit. Sleep and energy often move first. Body composition takes longer. I'd rather tell you that at the start than surprise you with it in week six.
About the author
Paola is a certified women's health and nutrition coach and breathwork practitioner at Fabulous in Midlife, helping women navigate perimenopause and menopause with practical, evidence-based support. Follow along on Instagram and Facebook @fabulousinmidlife or visit fabulousinmidlife.com.
