Menopause is something literally every woman will experience in her lifetime, yet it is still too often misunderstood in the clinical setting. Doctors tend to default to viewing menopause either as a series of unrelated conditions or a trivial symptom of aging, when in fact it is a natural transition in the body involving the systemic loss of estrogen, progesterone, and testosterone.
Why has menopause been mismanaged and, in some cases, ignored in the medical community? And what can we do as functional medicine practitioners to remedy this oversight and address menopause in ways that truly help our patients?
Why Menopause Is Mismanaged
This mismanagement happens for a multitude of reasons, several of which we’ll cover below, but one needs to be mentioned up front: Menopause has historically been underfunded and under-researched. Until recently, for example, the National Institute of Health excluded women from many studies. Additionally, research in fields like cardiology and neurology has been largely male-focused. Consequently, the evidence guiding menopausal care is often built on a foundation of male physiology!
Moreover, medical schools often minimize menopause in their curricula, with some providing fewer than three hours of total training on the subject. This leaves the vast majority of doctors unprepared to manage menopausal symptoms in their patients.
Most practitioners assess menopausal women system by system, sending them to cardiology for arrhythmias, psychiatry for mood changes, and urogynecology for atrophy. They never connect these presentations to a single hormonal transition, instead treating symptoms in isolation while the underlying transition progresses unchecked.
“Perimenopause and Menopause: A Five-System Clinical Approach,” taught by Leslie Fuller, ND, and Jillian Moehle, ND, is designed to help practitioners reverse course. This Kharrazian Institute Master Class distills the clinical evidence on menopause into a systematic, five-system framework for assessment and treatment.
Rather than focusing on isolated symptoms, you will learn to recognize menopause as a unified event. You will get the tools you need to stop sending unnecessary specialist referrals, quit prescribing trial-and-error medication protocols, and end the normalization of age-related decline.
Why Menopausal Women Suffer in Silence
Cultural minimization
Menopause is also often overlooked when it comes to medical care. A major culprit is cultural minimization. Over the last few decades, social and cultural narratives have downplayed the importance of menopause.
Midlife health concerns have been framed as “just aging” or something that women should “just endure”:
- Hot flashes and mood changes are treated as jokes or trivial complaints.
- Cognitive changes like brain fog are dismissed as normal or age-related stress.
- Sexual health changes are ignored or stigmatized rather than understood and treated.
Medical siloing
Medical siloing is another obstacle for menopausal women seeking care. In a clinical environment, menopause is often broken down or isolated into symptoms rather than being considered as a holistic, whole-body transition:
- A menopausal woman with a new heart arrhythmia is sent to a cardiologist rather than a hormonal specialist.
- A woman experiencing poor sleep quality is treated for insomnia rather than progesterone withdrawal.
- A woman with brain fog is prescribed antidepressants, and her doctor misses the deeper, hormone-related root causes.
The WHI study
Perhaps the biggest obstacle related to menopausal care is the infamous Women’s Health Initiative (WHI) study. Run from 1993 to 2002, this study caused 20 years of fear regarding hormone therapy.
The WHI study was a massive clinical trial designed to investigate the effects of menopausal hormone treatment (MHT) on the risk of non-communicable diseases in post-menopausal women. Unfortunately, the way the study's data was presented to the public created a lasting legacy of misunderstanding.
As just one example, media reports focused on relative risk—stating a "26 percent increase" in breast cancer—which sounded much more alarming than the absolute risk of only one additional case per 1,000 women per year.
Moreover, the study itself suffered from several limitations, including:
- The average age of participants was 63, significantly older than most women entering menopause.
- The study focused on synthetic hormones, rather than bioidentical options often used today.
- The initial findings did not account for the timing of hormone-therapy initiation related to the onset of menopause.
Nevertheless, the study led to a generation of practitioners who were hesitant to prescribe hormones for menopausal patients, even when they were clinically indicated.
Why do your smartest, most health-conscious patients suddenly develop brain fog, lose muscle despite exercise, gain visceral fat without weight gain, and experience injuries that won’t heal?
“Perimenopause and Menopause: A Five-System Clinical Approach” by Leslie Fuller, ND, and Jillian Moehle, ND, answers this question by distilling how the loss of estrogen, progesterone, and testosterone leads to predictable, multisystem physiological changes.
When you take this course, you will gain the tools you need to:
- Recognize symptom clusters as diagnostic evidence
- Understand why current bioidentical formulations differ from older research
- Assess all five affected systems in sequence
- Identify the critical intervention window
- Implementing layered protocols that address multiple pathways simultaneously
Each module is grounded in current evidence and practical workflows you can start using immediately.
Modern Menopause Management Paradigms
As functional medicine practitioners, our goal is always to provide holistic care that guides our patients back to full health. We’ve seen what it looks like when that doesn’t happen. So what does effective care for women during menopause actually look like?
As with many health issues, lifestyle support and modification should always be foundational for any menopause care protocol. They are cost-effective and safe, and they have broad health benefits.
Furthermore, systematic reviews and meta-analyses consistently show that exercise and nutritional interventions reduce depressive and anxiety symptoms with effect sizes comparable to pharmacological treatments in mild-to-moderate cases of menopause.
In practice, this looks like:
- A nonnegotiable focus on whole foods that are high in protein and fiber and help regulate blood sugar
- Resistance training and aerobic exercise for muscle and cardiovascular health
- Prioritizing sleep hygiene and practices like mindfulness to stabilize the nervous system
- Normalizing menopause as a neuroendocrine shift rather than a sickness
Once the foundation has been established, more severe cases of menopause may call for targeted functional strategies, including:
- Utilizing CoQ10, alpha-lipoic acid, and L-carnitine to improve cellular energy production
- Prescribing omega-3 fatty acids and curcumin to reduce brain and joint inflammation
- Using phytoestrogens like soy, flaxseed, and red clover or adaptogens like ginseng and kava to provide gentle receptor support and manage mood
And when lifestyle and functional interventions are not enough, pharmacological therapy serves as a last resort:
- MHT can be prescribed for FDA-approved indications like hot flashes, genitourinary symptoms, and osteoporosis prevention
- Medications like selective estrogen receptor modulators (SERMs) can be used for vaginal health
- GLP-1 agonists can be employed for metabolic dysfunction when appropriate
Perimenopause and Menopause: A Five-System Clinical Approach by Leslie Fuller, ND, and Jillian Moehle, ND
Menopause affects 100 percent of women. Unfortunately, the medical community has a history of misunderstanding, downplaying, and even ignoring menopause, leaving many women to suffer in silence. But as a functional medicine practitioner, you can successfully manage symptoms of menopause in your patients—you just have to know what to do.
This is the driving force behind the latest Kharrazian Institute Master Class, “Perimenopause and Menopause: A Five-System Clinical Approach,” by Drs. Leslie Fuller and Jillian Moehle. The course covers five modules on menopause that reframe scattered symptoms as integrated physiology. You will learn the evidence-based assessment and treatment protocols you need to give your menopausal patients the help they deserve.
You can learn more and register here.
Leslie Fuller, ND, is a residency-trained naturopathic physician and full-time professor at the University of Western States, where she teaches clinical neurology, nutrition, and laboratory assessment.
Jillian Moehle, ND, is a Naturopathic and Functional Medicine Physician based in Portland, Oregon, where she provides integrative primary care with a focus on perimenopause, menopause, and cardiometabolic health.
Frequently Asked Questions
Why do conventional medicine models frequently fail menopausal and perimenopausal patients?
Conventional medicine is built on a siloed approach, with doctors often treating the body as a collection of separate parts rather than a unified system. When a menopausal patient develops multiple symptoms, she is often sent to several different specialists, and the underlying cause—a hormonal transition—is missed.
Why is there still so much hesitation around prescribing menopausal hormone therapy (MHT)?
Most of the fear stems from the infamous Women’s Health Initiative (WHI) study. Media reports at the time alarmed the public by focusing on relative, not absolute, risk. Furthermore, the study looked at synthetic hormones given to women with an average age of 63. It did not reflect modern bioidentical hormone options or the benefits of starting therapy earlier.
What are the primary lifestyle interventions that show clinical efficacy for menopause?
Research shows that lifestyle modifications can be just as effective as medications for mild-to-moderate symptoms of menopause. Clinical focus should be placed on nutrition, exercise, and stress care.
How can I transition my practice from treating isolated menopausal symptoms to using a systematic, evidence-based treatment model?
Moving away from a trial-and-error approach requires a structured framework that views menopause as a unified, whole-body event. In the Kharrazian Institute Master Class, “Perimenopause and Menopause: A Five-System Clinical Approach,” taught by Leslie Fuller, ND, and Jillian Moehle, ND, you will learn how to do this. This evidence-based course teaches you how to map symptom clusters, assess all five affected bodily systems in sequence, and implement layered functional protocols.
