Perimenopause, the transitional phase preceding menopause, is marked by hormonal fluctuations that contribute to vasomotor symptoms, mood changes, sleep disturbances, and metabolic shifts. This review explores integrative approaches to managing perimenopausal symptoms and promoting long-term health. Nutritional strategies, including plant-forward diets and phytoestrogens, may alleviate vasomotor symptoms and support cardiovascular and bone health. Movement and mind-body practices such as yoga and resistance training improve physical and psychological well-being. Selected supplements show promise for sleep, mood, and sexual function, though evidence varies. Supplements including calcium, vitamin D, magnesium, and vitamin K2 support bone health, while hormone therapy remains the most effective treatment for vasomotor and genitourinary symptoms. Individualized care that integrates lifestyle, nutritional, botanical, and conventional therapies can enhance quality of life and support healthy aging. Clinicians should engage in shared decision-making to tailor interventions to patient preferences and risks, empowering patients through the menopause transition and beyond.