Perimenopause, Decoded

A Functional Medicine Q&A with Dr. Amanda Cohen, M.A., D.A.O.M, L.A.c, Dipl. OM

Perimenopause is one of the most transformative—and often confusing—chapters in a woman’s life. From shifting hormones to sleep struggles, mood swings, and weight changes, it can feel like your body is rewriting the rules overnight. That’s why we’re thrilled to welcome Dr. Amanda Cohen, founder of Source Point Wellness, to help demystify the process and share a more holistic path forward.

Dr. Cohen is not only a licensed acupuncturist and functional medicine practitioner—she holds a Doctorate (DAOM) in Chinese Medicine and has a Masters in Health Psychology and Social Ecology with decades of experience helping women thrive through life transitions. She practices in Los Angeles but also treats patients worldwide via telemedicine. In this exclusive Q&A, she breaks down what’s really happening in the body during perimenopause, what symptoms to pay attention to, and how to support yourself naturally and effectively.

Whether you’re just starting to notice changes or deep in the thick of it, this conversation is packed with clarity, compassion, and real-world advice from a trusted expert.

Q 1. What exactly is perimenopause, and how is it different from menopause?

During perimenopause, women often feel like they’ve lost themselves. My role is to help them reconnect—by validating their symptoms, deeply listening, and investigating root causes of hormonal shifts.

I help women during the latter part of their reproductive cycle (perimenopause and menopause) feel more at home in their bodies and minds, reclaim balance and vitality, and find more freedom and peace during this often destabilizing life transition.  My patients and I work together as a team to make sustainable treatment plans with lasting results. 

As a Doctor of Chinese Medicine and practitioner of Functional Medicine, I’ve had great success in balancing hormones of girls, teens, and women throughout their reproductive years. I am a health detective and address root causes of hormonal imbalances and customize treatment plans based on functional medicine, in-depth labs, chinese herbs and acupuncture. I have a Masters in Health Psychology and Social Ecology so I care deeply and address the mental and emotional health of my patients, their home environment, social relationships, and make sure they feel validated, safe and supported in my care. 

Menopause is the end of menstruation. Perimenopause is the transition into menopause and can start as early as 10 years before one’s menstrual cycle stops. During perimenopause, our bodies start to shift and speak to us (sometimes scream at us) in new ways. I help to decode and understand what each person’s body is communicating to them and support their mind and spirit along the way. 

Q 2. What are some of the most common symptoms women experience during perimenopause and which ones tend to get overlooked?

The main issue I am seeing in my patients in their late 30s through early 50s is weight gain (and yes I successfully help with this). This is often just excused by many docs as “normal for aging.”  It’s not normal - it’s inflammation. In many cases, what presents as weight gain may actually be inflammation or fluid retention driven by hormonal and metabolic shifts—even when lifestyle factors remain stable.

During perimenopause, there are rapid shifts in hormones which can account for physical issues such as weight gain and metabolic sluggishness, brain fog, fatigue, changes in temperature like hot flashes or cold spells, heart palpitations and cardiovascular issues, loss of muscle mass, migraines, muscle and joint pain, especially in the low back, hips and knees, vaginal dryness and pain (vulvodynia and vaginismus) and pelvic floor dysfunction.

Shifting hormonal levels can create neuroinflammation, so addressing inflammation throughout the entire body and brain is paramount in comprehensive and effective perimenopausal support. Emotional issues can skyrocket during perimenopause such as severe anxiety, agitation, depression, insomnia, rage, inability to manage stress. In fact, the other 2 most common issues I see during perimenopause are insomnia and anxiety.

Q 3. From a functional medicine perspective, what’s actually happening in the body during this time?

Oftentimes taking hormones often does not address the myriad of symptoms women experience during perimenopause. I often hear from many patients in their late 30s, 40s and early 50s say “I never had this issue before… so why now”? Perimenopause. 

Why does inflammation flare up during perimenopause? Hormones are anti-inflammatory, immunoprotective, and cardioprotective. Declining hormone levels during perimenopause unmask or amplify long-standing inflammation and imbalances in the body—often years in the making.

Perimenopause is sometimes called “inflammopause”. As a functional medicine physician, my role is to become an inflammation huntress. I track root causes that may stem from the gut, thyroid, brain, immune system, or even unresolved trauma to get efficient, quick and lasting results. Every woman is different so each treatment plan will be individualized; all my patients get personalized integrative medicine and a whole lot of TLC from me.

Hormones and inflammation (a quick synopsis) 

Balanced estrogen is protective for the body and is anti-inflammatory. Estrogen also regulates immune function. As it dips, we see a rise or progression of autoimmune disease and pain. Progesterone is anti-inflammatory and immune regulating and very important in mood regulation. As it drops, anxiety, depression and insomnia tend to rise. 

Testosterone is important for libido, vulvo-vaginal skin health, metabolism, bone and muscle strength, and energy. Testosterone is also very important for supporting the bladder and pelvic floor. I often see a rise in pelvic floor pain and hypertonicity in perimenopause. 

The decline of ovarian hormones in perimenopause coupled with underlying unchecked inflammation can create multiple imbalances in physical and neurological systems. I assess all possible cogs (stress, thyroid issues, gut imbalances, toxins, viruses) in the wheel that could be creating inflammation during perimenopause. I practice HPO- Axis optimization. The HPO axis is called the Hypothalamic–pituitary–ovarian axis and is the balance and communication system between the brain, thyroid, gut and hormones. 

Common causes of inflammation include: 

• Anemia (not enough blood, iron or b12)

• Infection or bacterial overgrowth

• Parasites 

• Blood Sugar fluctuations

• Toxins (molds, chemicals, heavy metals, plastics parabens)

• Gut imbalances

• Allergies and food sensitivities 

• Viruses and lyme 

• Toxic relationships 

• Unfulfilled life purpose (I address this a lot in my acupuncture treatments with esoteric and existential acupuncture) 

• Trauma 

  
  

During perimenopause, the body is operating on a different level and different pace. Proper testing and holistic individualized treatment plans including the mind, body and spirit will help me better understand what my patients’ evolving bodies need so I can set them up for radiant health for the rest of their lives. 

Q 4. How do you approach supporting a woman through perimenopause in your practice?

Trust,  Teamwork and Compassion 

I am interested in the person behind the symptoms of perimenopause. I love learning everyone’s story, and talking about the evolution of their symptoms and their health and life goals. Each of my patients I hold deeply in my heart and make sure they feel validated, loved and supported as we are on their journey together.

Comprehensive Testing and Detective work 

Comprehensive labwork is the first step assessing how to effectively treat the inflammation and hormonal imbalances that occur in perimenopause. Testing hormone levels is the most important first step in supporting a woman in perimenopause. Oftentimes, doctors prescribe hormones without thorough testing. I need baseline levels to see how their body is responding to hormonal treatment (whether western, eastern or natural medical treatments). 

As many women complain of weight gain in perimenopause, I do a thorough assessment of the thyroid (including testing for Hashimoto's Hypothyroidism) and gut assessment via stool test. I also test red and white blood cells to see if there is any infection, anemia, deficiencies in liver and kidney function, vitamin d and B vitamins (often these are low), iron, autoimmune disorders, celiac and gluten sensitivity, allergies and food sensitivities. 

As cardiovascular issues can become pronounced in perimenopause, I also do a complete lipid panel with several additional markers for cardiovascular health and longevity. 

I test several markers of glucose metabolism. One of the biggest influences on hormonal health is balanced blood sugar. Blood sugar fluctuations and insulin spikes are the one of the biggest causes of hormonal imbalances. I love the book “Glucose Revolution" by Jessie Inchauspé and recommend it often to my patients.

As perimenopause is an inflammatory time, I also test several markers of inflammation. I test hormones through blood, urine and saliva (including adrenal health) to get a vast picture of a woman's hormonal baseline.  I test for nine adrenal markers, 13 different types of estrogen markers, 5 types of progesterone,  8 types of testosterone markers, and estrogen disrupters and bone health. 

If I see that there are digestive symptoms and elevated neutrophils (signs of bacterial overgrowth), I will also order a stool test. Toxins can wreak havoc on our hormonal, immune systems, metabolism and neurological health.  If I suspect that the patient has toxin exposure (toxins are major hormone disruptors), I will test their total toxins (including molds, pesticides, heavy metals, plastics, parabens and manmade chemicals called PFAS). In some cases, I may do a complete viral and lyme assessment if there is severe fatigue and frequent colds and flu. 

Everyone is different. Sources of inflammation will also be different, so it’s important to get a full picture of the entire system and health history to have a streamline effective and lasting treatment for perimenopausal support. 

Root Cause Treatment Plan 

After I collect all the lab results, my patient and I make a plan to balance the hormones (the branch), nourish the body, and quell inflammation in the body (the root). I make sure their blood is strong (no anemia), the blood sugar is balanced, overgrowth of bacteria, yeast or parasites are treated, the cardiovascular, neurological and immune systems are supported, and the toxins, chemicals and hormone disrupters are removed from the body. I also make sure that their homes are free of toxins, mold, the water is clean (purified) and the air is clean. 

Mind-Body-Spirit Integration

I provide Chinese Medicine to bring peace, balance and nourishment to the body and mind, and help my patients feel more at home in their bodies. With acupuncture and Chinese herbal medicine, I can balance hormones, calm the nervous system, rapidly reduce inflammation and help nourish and revitalize the mind, body and spirit. I can turn down the dial of the fight or flight system (sympathetic nervous systems) and turn up the dial of the rest and digest systems (the parasympathetic nervous system). 

Perimenopause can be a time of blossoming if you have the right doctor guiding you through it. Having someone who is a health detective, compassionate and committed to freeing you from discomfort can be the best investment in your health during perimenopause to set you up for success for the rest of your life to live long and live well. 

Q 5. So many women are told “this is just part of aging” and left to suffer-what would you say to someone who feels dismissed or unheard by their doctor?

If a doctor tells you it’s ‘just aging,’ what they may really be saying is, ‘I don’t have the tools or time to investigate further. Pain, inflammation, depression, weight gain and illness (as well as all the symptoms above of perimenopause) is NOT normal… at any age. 

I practice empowerment medicine. Most often, people leave my office glowing and joyful. The number one thing I do in my practice is to create a safe space where my patients feel heard, validated and nurtured by me and our collaborative work together. I became a doctor because I was often dismissed for my symptoms by many doctors. My goal is to be the doctor I wish I always had when I thought my body was failing me. 

“The body isn’t failing. It’s speaking. You just need someone who knows how to listen.”

Addressing only hormones can sometimes bring relief; but, if you are on hormones and still feeling symptoms of perimenopause, please consult a functional medicine physician trained in functional endocrinology like me to help you get lasting results targeted towards addressing underlying systemic imbalances. 

We know our bodies more than anyone else. I teach my patients how to decode what their body is telling them so that they can better transition to menopause with confidence and empowerment. 

Q 6. Are there specific lab tests or assessments you recommend for women in their 40s who want to understand what’s going on beneath the surface?

Here are my recommendations for root cause testing:

Nutrient & Organ Health: CBC with differential, Vitamin D, B12, Folate, Iron, Ferritin, Chem panel, magnesium, potassium, calcium

Autoimmune & Inflammation: ANA, CRP, ESR

Hormones and Thyroid: Estrogen, Progesterone, Testosterone, DHEA, FSH, LH, Pregnenolone, TSH, T3/T4, free T3 and Free T4, TgAb, TPOAb,

Metabolic & Cardiovascular: Lipid Panel, A1C, Insulin, CRP, ESR, Glucose

Gut & Toxins: Stool Test, Toxin Panel, Celiac and non celiac gluten sensitivity, Total IgG and Total IgE

Infectious/Chronic Illness: Lyme and Viral Panel

Q 7. What are some key lifestyle or nutritional changes you recommend during this phase?

I want my patients to be strong now and for the rest of their lives. I personally workout 6 days a week for at least an hour.  I am 44 and never felt better or more fit in my life. I stay strong and fit for my health now and also I want to live long and well and increase my healthspan (the period of a person's life when they are healthy and free from significant disease or disability). 

It’s so important to protect our bones and muscles to prevent fractures and bone softening as we age. Plus, feeling strong is a huge confidence boost!  I encourage my patients (if physically able) to be on a fitness routine where they are strength training at least 3 days a week and engaging in at least 30 min of higher intensity cardio. 

I encourage my patients to eat organic as much as possible and live an 80/20 lifestyle. Eat an anti-inflammatory, whole-foods-based diet 80% of the time, and leave 20% for joy, fun  and flexibility—this creates sustainability. I advise whole foods and also recommend personalized diets based on labwork. 

I like to talk to my patients about their personal and career goals, and help them have the energy and inspiration to pursue those goals, now that their minds and bodies are becoming more in sync. 

Q 8. How can women begin to shift their mindset around perimenopause-from frustration to empowerment?

We’re not declining—we’re refining.

One of my favorite sayings is to honor the cycles and seasons of our bodies. We (myself included in my mid-40s)  are shifting and blossoming towards a new chapter in our lives where even though our periods are on the way out, we are just getting started. 

We are entering a stage of freedom, stability, radiance, creativity and greater wisdom and self love if we can just listen and stop fighting our bodies. With the support of a well trained collaborative and compassionate functional medicine physician and/ or Chinese Medicine physician, we can learn to stop judging and being mean to ourselves and shift toward a place of self compassion and a greater understanding of our own internal rhythms. Empowerment starts with information, support, and a reframing of your symptoms not as ‘problems’ but as messengers asking for deeper care.” 

Q 9. Do you have any favorite rituals, practices, or therapies (like acupuncture or herbs) that you’ve seen make a big impact for women going through this transition?

In Chinese medicine, the body is seen as a garden: we nourish the soil (qi, blood, jing), water the roots (yin), warm the energy (yang), clear the weeds (dampness), and restore flow (qi and blood). As we shift through perimenopause, we need to tend to our inner and outer gardens in a new way. It’s the time of deep listening and creating more of a life of purpose and balance and flow. Acupuncture and Chinese Medicine are the key to finding that flow. 

Even though I have been in practice for over 10 years, I am amazed at how effective Chinese Medicine can be for treating hormonal imbalances, perimenopause, menopause and long standing pain and inflammation. When you combine Chinese Medicine with functional medicine, the results are astounding. 

Q 10. Lastly, what’s one thing you wish every woman in perimenopause knew about her body and her power during this stage of life?

Perimenopause is a time where we start to listen more deeply to the language of our bodies and minds. It’s a time to see what’s working in our partnerships, career and life’s purpose and setting up the rest of our lives to live fully our authentic life purpose with a body and mind that can support us as we evolve into our best, most radiant selves. 

If you feel dismissed, trust yourself—find someone who listens, investigates, and walks beside you. Perimenopause isn’t the beginning of the end—it’s the beginning of your becoming.

If you need support on your journey with perimenopause, feel free to

Email me at: drcohen@sourcepointwellness.com 

Check out my website: Source Point Wellness

Find me on Instagram: @doctoramandacohen

Or feel free to book and appointment: here