October 11, 2026  ·  Christy Mahoney, LAc, MSTCM, FDN‑P

Perimenopause and Menopause: When Your Body Starts Playing by a Different Set of Rules

Maybe you don't feel like yourself anymore.

You're exhausted, but somehow you can't sleep. Your body composition is changing even though you haven't dramatically changed the way you eat. Your clothes fit differently, especially around your middle. You feel puffy or bloated for no obvious reason.

Your periods may be heavier, lighter, closer together, farther apart, or completely unpredictable. One month you feel almost normal and the next month your hormones seem to have staged a revolt.

Perhaps you've developed heart palpitations, headaches, breast tenderness, joint pain, digestive issues, brain fog, anxiety, irritability, night sweats, or an inability to handle stress that used to barely faze you.

Your libido may have disappeared. Your hair may be thinning. Your skin feels different. You wake up at 3 a.m. and can't get back to sleep. You suddenly feel hot when everyone else in the room is comfortable.

Or maybe the most frustrating part is that you've had bloodwork done and were told that everything looks "normal."

And yet, you know you don't feel normal.

Welcome to the often confusing landscape of perimenopause.

Perimenopause Is More Than Hot Flashes

When people think about menopause, hot flashes are usually the first thing that comes to mind. But the hormonal transition leading up to menopause can affect nearly every system in the body.

Perimenopause commonly begins sometime in the 40s, although changes can start earlier. It can last for several years before menopause, which is officially reached after 12 consecutive months without a menstrual period.

During this transition, estrogen and progesterone don't simply decline in a smooth, predictable line. Hormones can fluctuate considerably. Ovulation may become less consistent. Progesterone production can decrease as cycles become more frequently anovulatory, while estrogen may swing from relatively high to quite low.

At the same time, this hormonal transition is happening within the context of everything else occurring in your body.

Things like thyroid function, blood sugar and insulin, digestive health and the microbiome, nutrient status, stress, sleep, inflammation, liver function and hormone metabolism all matter more at this stage of life than they may have in the past. Muscle mass and metabolic health become increasingly important, as do environmental exposures and the cumulative effects of everything your body has navigated over the previous 40 or 50 years.

This is one reason I don't believe women in this stage of life should automatically be handed the same generic "menopause protocol." Two women can have almost identical symptoms for very different reasons, and understanding those differences is where truly individualized care begins.

The Symptoms Can Show Up in Places You Wouldn't Expect

Hormonal changes during perimenopause and menopause can affect much more than your menstrual cycle.

Women commonly experience some combination of:

For some women, the transition is relatively uneventful. For others, it can feel as though their entire body changed within a few years.

And because many of these symptoms are nonspecific, they can easily be attributed to aging, stress, lack of sleep, or simply "being hormonal."

I think women deserve a more thoughtful investigation than that.

This Is Where Integrative Medicine Can Be So Powerful

One of the reasons I love combining Traditional Chinese Medicine with functional medicine is that the two systems approach the body from very different perspectives, yet they complement each other beautifully. Traditional Chinese Medicine asks us to look at patterns within the whole person, while functional medicine looks at interconnected systems and the potential root causes behind symptoms. Functional testing can add another layer of objective information about what may be happening beneath the surface.

Conventional medicine also has an important place, providing screening, diagnosis, imaging, bloodwork, medications, and hormone therapy when appropriate. These approaches do not have to compete with one another. In fact, I believe some of the best care happens when we stop thinking in terms of one system versus another and instead consider what each can contribute.

In my practice, I prefer to ask a different question: What combination of tools will give us the clearest picture of what this particular woman's body needs?

That answer will not be identical for everyone.

Traditional Chinese Medicine Has Been Treating Women's Health for Centuries

Long before we could measure estradiol, progesterone, cortisol, insulin, or thyroid hormones in a laboratory, Chinese medicine practitioners observed the patterns that occur throughout a woman's reproductive life.

Traditional Chinese Medicine, or TCM, does not look at menopause as a single hormonal deficiency.

We look at the entire pattern.

In Chinese medicine, symptoms that appear unrelated through a Western medical lens can sometimes form a recognizable pattern when viewed together.

Acupuncture and Chinese herbal medicine can then be customized to that pattern rather than treating "menopause" as though it were one condition.

Acupuncture During Perimenopause and Menopause

Acupuncture can be a wonderful supportive therapy during this transition because treatment can evolve as your symptoms change. A woman might initially come in because she isn't sleeping, but during our conversation I may also learn that she is experiencing increased anxiety, digestive changes, headaches, muscle tension, fatigue, irregular periods, or night sweats. These symptoms don't necessarily need seven separate treatments. They may be different expressions of a larger pattern of imbalance, which is one of the reasons looking at the whole person is so important.

Acupuncture treatments can be designed to support nervous system regulation, sleep, digestion, pain, headaches, stress, and vasomotor symptoms such as hot flashes and night sweats. But there is also something inherently therapeutic about simply having a place where your body can settle.

Many women in their 40s and 50s are simultaneously managing careers, teenagers or young adult children, aging parents, relationships, financial responsibilities, and major questions about what they want the next phase of their lives to look like. With so much constantly requiring our attention, the nervous system rarely gets the memo that it is allowed to stop. For many of my patients, the acupuncture table becomes one of the few places where they truly do.

Chinese Herbal Medicine Allows Us to Go Even Deeper

Chinese herbal medicine gives us another layer of individualized support. Rather than choosing an herb simply because it is supposedly "good for menopause," Chinese herbal formulas are traditionally selected according to the person's overall pattern and how symptoms are showing up in her particular body.

A woman who is hot, restless, waking at night, and experiencing night sweats may need a very different approach from a woman who is exhausted, cold, retaining fluid, and struggling with digestive issues. Likewise, someone experiencing heavy, frequent periods may require an entirely different strategy from someone whose periods have become increasingly scanty and far apart. This level of individualization is one of the things I value most about Chinese medicine.

Herbal medicine can also be thoughtfully integrated with nutritional supplements, medications, and hormone replacement therapy when appropriate. This is an area where professional guidance matters, because more supplements and more herbs do not automatically lead to better results. The goal is not to add as many things as possible. The goal is to create a coherent treatment plan in which each piece has a purpose.

Functional Medicine Helps Us Ask Why

Traditional Chinese Medicine gives me one lens through which to understand your symptoms, while functional medicine gives me another. Instead of simply stopping at "you're tired," we can ask a much more useful question: Why are you tired?

Maybe your sleep is disrupted, your iron status is less than optimal, or thyroid function is part of the picture. Blood sugar fluctuations may be affecting your energy, or perhaps you're not getting enough protein and key nutrients to support your changing metabolic needs. Chronic stress may be interfering with recovery, while digestive issues can affect how well you're absorbing nutrients. Inflammation, medications, and hormonal changes can all contribute as well. For some women, it may also be worth discussing whether hormone therapy is appropriate or, if they're already using it, whether their regimen should be reevaluated with their prescribing provider.

Often, there isn't one answer. There may be several different threads contributing to the very same symptom. That is why I describe health as a tapestry. Pulling on one thread can affect many others.

Test, Don't Guess

One of the principles I use in functional medicine is simple: Test, don't guess. But that doesn't mean everyone needs every functional test available. Quite the opposite. Testing should have a purpose, and before ordering anything, I want to know what question we're trying to answer and whether the results have the potential to change what we do next.

Depending on your health history, symptoms, and what we already know, functional testing can help us investigate areas that may be difficult to fully understand based on symptoms alone. The goal isn't to collect more data for the sake of having it. It's to gather the right information to help us make more informed and individualized decisions about your health.

DUTCH Hormone Testing

The DUTCH test can provide a more detailed look at sex hormones, adrenal hormones, and the ways certain hormones are being metabolized. Depending on the specific test ordered, it can evaluate estrogen and progesterone metabolites, androgen metabolites, as well as cortisol and cortisone patterns throughout the day.

This can be especially useful when a woman's symptoms suggest that the picture is more complicated than simply having "high estrogen" or "low estrogen." Hormone levels are important, but how the body metabolizes those hormones can matter too.

For some women, DUTCH testing can provide another valuable piece of the puzzle when considered alongside symptoms, menstrual history, conventional laboratory testing, medications, and hormone therapy. It isn't a replacement for conventional bloodwork or appropriate medical evaluation. It simply gives us another lens through which to understand the larger picture.

GI-MAP and the Gut-Hormone Connection

What does your digestive system have to do with menopause? Potentially quite a lot. Your gut microbiome interacts with metabolism, immune function, inflammation, nutrient availability, and estrogen metabolism, which means digestive health can be an important part of the larger hormonal picture.

The GI-MAP is a comprehensive stool test that evaluates gastrointestinal microorganisms along with selected markers related to digestive and intestinal function. Depending on a woman's history, I may consider comprehensive stool testing when hormonal symptoms occur alongside chronic bloating, constipation, diarrhea, reflux, abdominal discomfort, food reactions, or longstanding digestive issues.

If your digestive system isn't functioning well, simply adding more supplements may not solve the underlying problem. Sometimes we need to work on the terrain first.

MRT Food Sensitivity Testing

Some women notice that foods they previously tolerated seem to bother them more as they move through perimenopause. They may experience more bloating, headaches, joint pain, skin reactions, or increasingly unpredictable digestion. Food sensitivity testing such as MRT may sometimes be considered as part of a broader evaluation when clinically appropriate.

The goal is not to create a permanently restrictive diet. In fact, unnecessarily eliminating dozens of foods can make good nutrition more difficult and may reduce dietary diversity. When I use food sensitivity information, I want it to help us create a focused strategy while we continue asking the more important question: Why has your system become more reactive in the first place?

Organic Acids Testing

An Organic Acids Test, often called an OAT, provides information about certain metabolic byproducts found in urine. Depending on the test used, these markers can provide additional information related to nutrient needs, cellular energy pathways, oxidative stress, neurotransmitter metabolites, and other aspects of metabolism.

For a woman experiencing stubborn fatigue, brain fog, mood changes, or other complex symptoms, this information can sometimes give us another piece of the picture and help guide a more targeted nutritional strategy.

HTMA and Mineral Patterns

Hair Tissue Mineral Analysis, or HTMA, evaluates minerals present in a hair sample. Minerals are involved in an extraordinary number of physiological processes, including energy production, thyroid function, blood sugar regulation, muscle function, stress physiology, and bone health.

I don't interpret mineral testing in isolation or use it to diagnose disease. Instead, it can provide another source of information to consider alongside diet, symptoms, health history, medications, supplements, and other laboratory testing. This can become particularly interesting during the menopausal transition, when maintaining bone, muscle, metabolic, and cardiovascular health becomes increasingly important.

Nutritional Status Testing

Sometimes the question is much simpler: Does your body actually have the raw materials it needs?

Depending on the situation, nutritional testing may help us evaluate vitamins, minerals, fatty acids, amino acids, antioxidants, and other nutritional markers. A woman can eat a seemingly excellent diet and still have nutritional gaps because dietary intake is only one part of the story.

Digestion and absorption matter too, as do medications, alcohol intake, chronic stress, restrictive diets, gastrointestinal conditions, and increased physiological demands. All of these can influence nutrient status. Rather than blindly adding a long list of supplements, testing can sometimes help us be much more strategic about what your body actually needs.

Environmental and Toxic Burden Testing

For selected patients, testing related to environmental exposures or toxic burden may also be worth considering. This isn't something every woman needs, nor do I believe we should blame every unexplained symptom on "toxins." But exposure history can matter.

Where you live and work, past occupational exposures, water damage or mold exposure, hobbies, household products, and other environmental factors may all be relevant pieces of a complicated health picture. When testing is appropriate, the results should lead to a thoughtful plan focused on reducing meaningful exposures and supporting the body's normal elimination pathways rather than aggressive or indiscriminate "detoxing."

Don't Overlook Conventional Bloodwork

Functional medicine does not mean abandoning conventional laboratory testing. Quite the opposite. A tremendous amount of useful information can be found in standard bloodwork. The difference is often in how we look at it.

Conventional laboratory reference ranges are primarily designed to help identify disease and significant abnormalities. A functional medicine approach may also look for patterns within those ranges and consider whether the results make sense in the context of the person's symptoms, history, and overall health picture.

For a woman in perimenopause or menopause, I may want to look at a complete blood count and comprehensive metabolic panel along with thyroid markers, iron and ferritin, vitamin D, vitamin B12 and folate, fasting glucose and insulin, hemoglobin A1c, lipid and inflammatory markers, and sex hormones when appropriate. Additional testing may be useful depending on personal and family history.

The important point is that a result being inside the laboratory reference range doesn't automatically end the conversation. At the same time, a mildly abnormal result doesn't automatically explain every symptom. Labs need context.

The Metabolic Shift After 40 Deserves More Attention

One of the most frustrating things I hear from women is: "I'm doing the same things I've always done, but they're not working anymore."

I believe them. I notice the same thing happening in my own body. The strategies that kept you feeling strong and lean at 30 may not produce the same results at 48 or 58. Changes in estrogen, sleep, muscle mass, activity, stress, insulin sensitivity, and other factors can all influence body composition and metabolic health during this stage of life.

That doesn't mean weight gain is inevitable. It does mean the strategy may need to change. For many women, the answer isn't simply eating less and exercising more. We may need to look more closely at protein and fiber intake, strength training and muscle preservation, blood sugar regulation, alcohol intake, sleep, stress, thyroid function, medications, nutrient status, and overall caloric intake.

This is also the stage of life when I want women thinking beyond the scale. We need to protect bone and both preserve and build muscle. We need to pay attention to cardiovascular health and place much greater emphasis on insulin resistance and metabolic health, which can easily be overlooked when the conversation focuses primarily on weight. We also need to think about preserving strength, mobility, cognition, and independence for the decades ahead.

The goal isn't simply to make it through menopause. The goal is to build a body that can carry you well through the second half of your life.

What About Hormone Replacement Therapy?

I don't view hormone replacement therapy and natural or functional medicine as opposing camps. For some women, menopausal hormone therapy can be an important and appropriate part of care. For others, it may not be appropriate or simply may not be something they want to pursue.

Women who use hormone therapy can still benefit from paying attention to nutrition, metabolic health, cardiovascular risk, digestive function, sleep, exercise, stress, and the other foundational aspects of health. Hormones don't replace foundations, and acupuncture and other complementary approaches don't replace appropriate medical care either.

Integrative medicine works best when we stop insisting that there must be only one tool in the toolbox.

You Shouldn't Need a Cabinet Full of Supplements

One of the unfortunate trends in wellness is the idea that every abnormal marker requires another supplement. Before long, someone is swallowing 25 pills a day and no longer knows why she's taking half of them. That is not my goal.

Functional testing should help us become more targeted, not more complicated. If testing suggests a nutritional need, we can address it. If your digestive system needs support, we can work on it. If your food choices need adjustment, we can create a realistic nutrition plan. If an herbal formula fits your Chinese medicine pattern, we can use one. And if a supplement no longer has a clear purpose, perhaps it doesn't belong in your protocol anymore.

Quality matters too. When supplements are recommended in my practice, I use professional-quality products and create a customized plan based on the individual rather than handing every woman the same menopause supplement list.

Your Treatment Plan Should Look Like You

Imagine two 48-year-old women who have each gained 15 pounds. Both wake around 3 a.m., both are exhausted, both have irregular periods, and both are experiencing anxiety that wasn't present five years ago. On the surface, they sound nearly identical.

But when we investigate further, one may have significant blood sugar dysregulation, low iron stores, and a history of very heavy periods. The other may have digestive dysfunction, poor nutrient absorption, a very different stress pattern, and thyroid markers that deserve further evaluation.

Their acupuncture treatments may be different. Their Chinese herbal formulas, nutrition plans, supplements, and even the testing I recommend may be different. That is personalized medicine.

There Is Also a Woman Inside All of These Lab Results

This part matters deeply to me. Perimenopause and menopause are physiological transitions, but they are also life transitions. For many women, this is the first time in decades that questions begin to surface that have very little to do with caring for everyone else.

Who am I now? What do I want? What am I ready to let go of? What no longer fits? Where have I been pushing myself too hard? What have I ignored? What do I want the next chapter of my life to look like?

Sometimes the body gets louder during this stage. That doesn't mean every symptom has a psychological or emotional cause. It means that physical health doesn't exist separately from the rest of our lives.

Stress affects sleep, and sleep affects blood sugar. Blood sugar influences hormones, while hormonal changes can affect mood. Digestive health influences nutrient status. Pain affects movement, and movement affects metabolism. Our emotional lives can influence the way we experience all of it.

This interconnectedness is at the heart of why I created Tapestry Holistic Healing.

You Don't Have to Settle for "Everything Looks Normal"

If you are 40, 50, 60, or beyond and don't feel like yourself, there may be many avenues worth exploring. You may need a conversation with your physician about hormone therapy or a more comprehensive look at thyroid function. Perhaps iron or other nutrients need attention, your digestive health needs support, or your approach to food needs to change. You may need to build more muscle or give your body more recovery and less punishment disguised as exercise.

You may benefit from acupuncture, Chinese herbal medicine, targeted functional testing, or some combination of these approaches. Often, the answer isn't just one thing. It is a thoughtful combination.

This is the kind of medicine I believe in. It isn't about chasing symptoms one by one, ordering every test simply because we can, giving every woman the same supplement protocol, or assuming that feeling terrible is simply the price of getting older.

Instead, we investigate. We look for patterns. We test when testing will give us useful information. We combine ancient wisdom with modern laboratory data. And then we build a plan around you.

A Different Way to Navigate Midlife Health

I have spent more than two decades working with women through different stages of their reproductive and hormonal lives, and one thing has become very clear to me over those years: women's bodies are complex, interconnected, and remarkably individual.

Perimenopause and menopause make those connections particularly visible. This transition can certainly be challenging, but I also believe it can be an extraordinary opportunity to understand your body more deeply and become much more intentional about the way you want to age.

At Tapestry Holistic Healing in Lake Oswego, Oregon, I combine acupuncture, Chinese herbal medicine, functional medicine, nutrition, functional testing, and individualized lifestyle guidance to help women better understand what may be contributing to the way they feel.

Because your health isn't one isolated hormone, organ, symptom, or laboratory result. It is a tapestry. And sometimes the best way to change the whole picture is to finally understand how the threads are connected.

Ready to Feel Like Yourself Again?

If you would like to explore acupuncture, Chinese herbal medicine, or functional medicine support for perimenopause and menopause, schedule your appointment below.

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Have questions before deciding to work together? Call or text (971) 449-8677.

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