Navigating your health (whether you’re in your 20s, 30s, 40s, or 50+) can feel like an uphill battle. That’s especially true for women who are about to enter or who are in the throes of perimenopause. One moment you’re energized and focused, the next you’re wired, overheated, and completely spent. What’s happening and why?
According to Ayurvedic medicine practitioners and founders of Arvasi, Avanti Kumar-Singh, M.D and Tanmeet Sethi, M.D., these symptoms are a sign that the fire element of your body, or pitta, is brimming over—contributing to inflammatory and metabolic concerns. The solution isn’t to distinguish the fire. Rather, the goal is to find balance. Here’s what that means and how to take an integrative approach to calm your fire and find the symptom relief you crave.
What’s driving your symptoms?
Pitta is the dosha responsible for your metabolism, digestion, focus, and drive. And women between the ages of 25 and 55 (commonly referred to as the householder years in Ayurveda) need a lot of pitta, according to Kumar-Singh. While this range may feel broad, it encompasses a time when many women are excelling in their careers, partnering, having children, raising a family, and caring for elders.
“It’s common for women to have too much fire,” says Kumar-Singh. “The accumulation of that fire, if it isn’t balanced, will show up as menopausal symptoms like hot flashes, night sweats, brain fog, inflammation, aches, and pains.”
But, perimenopause itself can make that balancing act even harder due to shifting hormones.
“Estrogen and progesterone are actually anti-inflammatory. When you have a decrease of those hormones (as you go into midlife), you’re almost getting slammed from both directions,” explains Kumar-Singh. “This is why there is such a wide range of symptoms women experience.”
This increase of fire is another way of saying you have an increase in inflammation, which impacts more than your symptoms.
How this fire impacts your metabolic health
It also impacts your metabolic health, even showing up in your labwork. Sethi sees that most in biomarkers like CRP, cortisol, and insulin.
“If we’re talking about insulin, we know that as women go through menopause, they tend to become more insulin resistant, even without changes in diet or exercise,” says Sethi.
Sethi always looks at insulin levels, as it gives a better sense of the body’s inflammatory environment in real time. Plus, she emphasizes that the goal from a preventive medicine standpoint is to identify metabolic changes long before blood sugar levels (like HbA1c) indicate prediabetes or diabetes.
“Unfortunately, as insulin levels rise, they contribute to a more inflammatory environment and are closely connected with cortisol.”
Cortisol is a hormone that rises with stress, and can contribute to the midsection weight gain that many women experience during this time.
“Perimenopause (and menopause) is a metabolic transformation in the body,” says Sethi. “The question is how much is your metabolic pattern deranged and how much is it being supported by what you’re doing to counteract that?”
Calming your fire
There are multiple steps you can take to help calm the fire and your body’s inflammatory state. Here’s where Kumar-Singh and Sethi recommend starting.
Awareness
“Having awareness is always the first step,” says Kumar-Singh. “Why are you making the choices you’re making and why are you not making certain choices?”
She encourages the women to look through the lens of, Is this going to increase the fire in me or balance it?
Because, generally speaking, most of us have a general idea of what we should be doing. We know we need exercise, but is choosing to do a HIIT class when you’re sleep-deprived and anxious going to fuel or calm the fire? Are you having a lot of difficult conversations at home that are causing irritability? How is that increasing your fire?
Having this awareness lets you start connecting the dots between daily habits, choices, and situations to the symptoms and feelings you’re experiencing.
Gut health
One key area Sethi focuses on with her patients is gut health. The gut is where our fire is most active. “I look at gut health and how people are nurturing and calming their digestion,” she says.
Research shows that gut health and the health of our microbiome impact blood sugar control and anxiety. So improving gut health can have far reaching positive impacts across multiple body systems.
Improving gut health includes eating a fiber-rich diet (and getting at least 25-38 grams of fiber a day), including fermented foods in your diet, and staying physically active.
Sleep
The importance of a good night’s sleep should never be underscored. “If we’re not sleeping well, even one night of sleep deprivation can make our bloodwork look prediabetic,” says Sethi. “It raises insulin and glucose levels, disrupts appetite hormones, triggers cravings, heightens anxiety, and makes mood unstable. And that’s just one night. Imagine the impact over time.”
But improving sleep isn’t just about improving your sleep hygiene (although making sure your room is dark, cool, and quiet does help. Instead, Sethi starts by looking at the full picture.
“Are cortisol levels out of balance? Is there too much stress or anxiety? Are progesterone levels fluctuating? Progesterone is a calming hormone that supports restful sleep,” Sethi notes. “I also look at circadian rhythm—how we’re preparing for sleep and aligning with natural light cues, because circadian medicine is so crucial in perimenopause and menopause.”
Although Sethi emphasizes that good sleep is needed for these habits to be most effective.
Sethi also layers in an Ayurvedic approach to nutrition. “There are three main doshas body types in Ayurveda, and depending on your body type, we prescribe different kinds of foods and different kinds of spices to counteract that fire and to calm it down.”
Interested in learning what your Dosha is? Kumar-Singh and Sethi created the Dosha-DATA™ Assessment, which helps uncover the patterns behind your energy, digestion, sleep, and stress.
Hormone replacement therapy
Both Kumar-Singh and Sethi agree that HRT can benefit women, but it’s not the only thing that needs to be done.
“I find that the women who do best are those who have a strong foundation in lifestyle medicine alongside their HRT or other treatments,” says Sethi.
The takeaway
Perimenopause may feel like a confusing time, and one where you feel like you’re losing control of your body. But as Kumar-Singh and Sethi break it down here, the patterns underneath your symptoms actually make sense. The fire that’s powered you through years of responsibility, ambition, and caretaking can tip into overload. But it’s also something you can rebalance.
By noticing what fuels or calms that fire, supporting your gut, tending to sleep, and strengthening your metabolic foundation, you calm inflammation, improve metabolic health, and lessen your symptoms. As Kumar-Singh notes, women can start balancing that fire in their 30s and 40s to make the perimenopause and menopause transition that much easier.
Check out your peri/menopause+ guide for more expert-backed advice on navigating lifestyle modifications and HRT.
