Perimenopause Symptoms Decoded

Understanding Perimenopause Symptoms With Expert Guidance

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, perimenopause symptoms 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 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.

Q1. 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, perimenopause symptoms may show up as subtle shifts or sudden changes as our bodies start to communicate in new (sometimes loud) ways. I help decode and understand what each person’s body is communicating to them and support their mind and spirit along the way.

Q2. 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, and inability to manage stress. In fact, the other two most common issues I see during perimenopause are insomnia and anxiety.

These are some of the most common perimenopause symptoms, but many women don’t realize how interconnected they are with inflammation, metabolic health, and nervous system changes.

Q3. From a functional medicine perspective, what’s actually happening in the body during this time?

Oftentimes taking hormones 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 is individualized.

Understanding these inflammatory drivers is key to decoding perimenopause symptoms and supporting long-term hormonal balance.

Hormones and inflammation (a quick synopsis): Balanced estrogen is protective and regulates immune function. Progesterone is calming and helps regulate mood. Testosterone supports libido, metabolism, pelvic floor strength, bone and muscle integrity, and energy. When these decline, symptoms often arise.

The decline of ovarian hormones coupled with underlying inflammation can create multiple imbalances in physical and neurological systems. I assess all possible cogs in the wheel that could be creating inflammation during perimenopause. I practice HPO-Axis optimization, the communication system between the brain, thyroid, gut, and hormones.

Common causes of inflammation include: anemia, infections, parasites, blood sugar fluctuations, toxins, gut imbalances, allergies, viruses, toxic relationships, and even unfulfilled life purpose.

Q4. How do you approach supporting a woman through perimenopause in your practice?

1. Trust, Teamwork, and Compassion

I am interested in the person behind the symptoms of perimenopause. I love learning everyone’s story, hearing about the evolution of their symptoms, and understanding their health and life goals.

2. Comprehensive Testing

Comprehensive lab work is the first step in assessing how to effectively treat the inflammation and hormonal imbalances that occur in perimenopause. Testing hormone levels is foundational. Many women are prescribed hormones without a baseline, which makes it harder to see what’s driving perimenopause symptoms.

I test hormones through blood, urine and saliva, and assess thyroid function, gut health, blood sugar, cardiovascular markers, nutrient levels, toxins, and immune markers. Each person’s sources of inflammation vary, so a full picture is essential.

3. Root-Cause Treatment

After collecting all lab results, we create a plan to balance hormones, nourish the body, and reduce inflammation. I make sure blood sugar is stable, gut imbalances are treated, toxins are removed, and the cardiovascular, neurological and immune systems are supported.

4. Mind-Body-Spirit Integration

I provide Chinese Medicine to bring peace, balance and nourishment to the body and mind. With acupuncture and herbal medicine, I help calm the nervous system, rapidly reduce inflammation and help patients feel more at home in their bodies.

Perimenopause can be a time of blossoming with the right guidance.

Q5. 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?

If a doctor tells you it’s “just aging,” they may really be saying, “I don’t have the tools or time to investigate further.” Pain, inflammation, depression, weight gain and illness—and all perimenopause symptoms—are NOT normal at any age.

I practice empowerment medicine. I became a doctor because I was dismissed for my symptoms. My goal is to be the doctor I wish I had—someone who listens and investigates.

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

If hormones alone aren’t helping, it may be time to work with a functional medicine physician trained in functional endocrinology.

Q6. Are there specific lab tests or assessments you recommend for women in their 40s?

Here are my recommendations for root cause testing:

1. Nutrient & Organ Health: CBC with differential, Vitamin D, B12, Folate, Iron, Ferritin, Chem panel, magnesium, potassium, calcium
2. Autoimmune & Inflammation : ANA, CRP, ESR
3. Hormones and Thyroid : Estrogen, Progesterone, Testosterone, DHEA, FSH, LH, Pregnenolone, TSH, T3/T4, free T3 and Free T4, TgAb, TPOAb,
4. Metabolic & Cardiovascular: Lipid Panel, A1C, Insulin, CRP, ESR, Glucose
5. Gut & Toxins: Stool Test, Toxin Panel, Celiac and non celiac gluten sensitivity, Total IgG and Total IgE
6. Infectious/Chronic Illness: Lyme and Viral Panel

Q7. What lifestyle or nutritional changes do you recommend during this phase?

I want my patients to be strong now and for the rest of their lives. Strength training, balanced nutrition, and toxin reduction play a major role in reducing inflammation and stabilizing many perimenopause symptoms.

I encourage strength training, high-intensity cardio, an 80/20 whole-foods approach, lab-informed nutrition, and lifestyle practices that support energy and purpose.

Q8. How can women begin to shift their mindset—from frustration to empowerment?

We’re not declining—we’re refining.

Empowerment starts with information, support, and a reframing of your perimenopause symptoms not as problems, but as messages offering insight into your body’s needs.

Q9. Do you have favorite rituals or therapies that make a big impact?

Acupuncture and Chinese Medicine are incredibly effective for treating hormonal imbalances, inflammation, sleep issues, mood changes, and other perimenopause symptoms. When combined with functional medicine, the results are astounding.

Q10. What’s one thing you wish every woman knew about her power during this stage?

Perimenopause is a time to listen deeply to the language of your body and mind. Understanding your perimenopause symptoms helps you transition with more clarity, purpose, and confidence.

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.

For support on your journey, feel free to email me: drcohen@sourcepointwellness.com
https://sourcepointwellness.com/dr-amanda-cohen/
https://www.instagram.com/doctoramandacohen/

Book an appointment:
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