Progesterone falls first, and falls hard
Often by your late 30s. This drives the early signs (anxiety, sleep issues, shorter cycles, more PMS).
Functional Medicine Treatment
Perimenopause Treatment
You’re 38, 42, 47. You’re sleeping worse than you used to. Anxiety has crept in. Your cycles changed (shorter, longer, heavier, lighter, skipping). Weight that used to come off doesn’t. Your skin reacts. Your brain feels slower. You’re irritable in a way that doesn’t match the situation.
You went to your doctor. You ran a TSH. You were told your cycle is “still regular enough.” You went home no closer to understanding what’s happening.
What you’re describing is perimenopause. The 4 to 10 years before menopause when hormones become erratic before they go quiet. It’s the most chaotic hormonal season of a woman’s life and the most under-treated. The good news is, it’s also one of the most responsive to a thoughtful, root-cause approach.
What's Actually Happening
Perimenopause isn’t a steady drop. It’s volatility, and the volatility is what makes it hard.
What This Looks Like
Most clients work with us for 6 to 12 months in perimenopause. Some stay longer because the value of having a clinical partner who knows this stage well is significant. Many transition with us into menopause when the time comes.
The outcome we’re after: you feel like yourself again. You sleep. Your cycles aren’t running your life. Your weight responds to inputs again. Your brain works. You’re not white-knuckling your way through your 40s.
You'll find this approach effective if:
You're between 35 and 52 and your body has changed
Your sleep has fragmented in the last 1 to 5 years
Your cycles changed and your doctor said "you're still cycling so it's fine"
You feel anxious or low in a way that doesn't match your life
Weight responds differently than it used to
You're considering hormone therapy and want a careful approach
You want a clinical partner who understands this stage and offers more than an SSRI and a low-dose pill
Our Approach
Perimenopause is a moving target, so the protocol moves with you. We test, we read the cascade, and we build a plan that adapts as your hormones shift.
Step 1
Test the actual cascade
DUTCH for the full hormone picture. Blood panel with full thyroid, insulin, HbA1c, lipids with particle size, vitamin D, ferritin, B12, and inflammatory markers. The cortisol pattern (DUTCH covers this) is critical here because cortisol drives so much of the perimenopausal experience.
Step 2
Foundational support
Sleep architecture, blood sugar, strength training, protein, stress patterns, gut, and alcohol. We're honest about alcohol in perimenopause. Most women feel substantially better when they cut it back.
Step 3
Targeted protocol
Specific support for the specific pattern your labs show. Progesterone support if it's low. Insulin-supportive nutrition if labs call for it. Thyroid support if numbers are slipping. Adaptogens for cortisol if the pattern is disrupted. Specific micronutrients (magnesium, B-complex, omega-3, vitamin D) at therapeutic doses.
Step 4
Bioidentical hormones if indicated
Bioidentical progesterone is often a meaningful intervention in perimenopause for sleep, anxiety, and cycle stabilization. Bioidentical estradiol is sometimes appropriate, depending on the picture. We coordinate with prescribing partners. We don't push hormones, and we don't withhold them when they're the right call.
Step 5
Quarterly check-ins
Your protocol changes as your hormones change.
Most perimenopause cases work cleanly inside our Restoration program because of the testing complexity and follow-up cadence the work calls for.
Restoration
The most common starting point. Adds testing depth and 6-month support.
Concierge
Women with complex pictures (autoimmunity, prior cancer, multiple medication interactions) who want year-long, direct-access support.
Foundation
Early perimenopause cases with focused symptoms.
Please note specialty laboratory testing, insurance-related copays, and supplements are not included and vary based on individual needs.
Frequently Asked Questions
Mid-30s is normal for the earliest hormonal shifts. By 40, most women are in some stage of it.
Yes. Cycles are erratic, not absent. Contraception still matters until you've gone 12 months without a period.
For most healthy women, yes, and increasingly the data supports starting earlier rather than later. Bioidentical progesterone has the strongest case in early perimenopause.
We don't tell you what to do. We tell you what your labs show. Most perimenopausal women feel substantially better with much less alcohol. The data on this is consistent.
Yes. We have a full non-hormonal toolkit and many clients prefer it. Sometimes it's enough. Sometimes it isn't, and we revisit hormones together.
Why Well Empowered?
25 years of devotion to people thriving
IFM Certified Practitioner
Doctor of Chiropractic Medicine
Certified Nutrition Specialist (CNS)
Licensed Dietitian Nutritionist (LDN)
Masters of Science in Nutrition & Functional Medicine
Personalized, root-cause approach
Virtual consultations available
Stop White-Knuckling Through It
Free 15-minute call to outline what testing your case calls for and what the path forward looks like.
