When Functional Medicine Falls Short: What I Wish I’d Known Sooner About Women, Perimenopause, and Hormones
I found functional medicine in the aisles of Barnes & Noble in 2001.
Like many of us who wind up in this space, I wasn’t searching for it — but it found me. I stumbled across a book that challenged everything I had been taught, yet somehow struck a nerve that resonated as truth. It connected the dots between my symptoms in a way no physician ever had. And for the first time, I felt seen inside the complexity of my own body.
At the time, I was battling relentless sinus infections and gut dysfunction. The conventional approach had nothing for me but steroids, antibiotics, and more steroids — each round leaving me weaker, more symptomatic, and more frustrated. But this book—this lens—was different. It was rooted in the idea that the body is interconnected, that symptoms are signals, and that health isn’t simply the absence of disease.
That introduction planted a seed that would shape my entire career.
When Functional Medicine Felt Like the Answer
When I applied to midwifery school, I chose the University of Pennsylvania, drawn to the program because Wendy Grube was the director at the time. Wendy had collaborated with some of the most respected names in herbal medicine—David Winston and Aviva Romm—and brought their integrative lens into women’s health education.
The philosophy of midwifery resonated deeply: honoring physiology, trusting the body, and partnering with women rather than managing them. That core value system became the through-line of my work—whether I was attending births or sitting in a consult room.
In 2019, after years of midwifery practice and the inevitable burnout that comes from living in broken systems, I enrolled in my first formal training with the Institute for Functional Medicine (IFM) in Seattle. Ironically, it would be the last time IFM offered this conference in person.
me, mid lecture at IFM, Seattle, 2019
The experience was electric. The people I met felt like coming home. The material made sense of everything I’d seen but hadn’t fully known how to explain.
Siete Foods, still a small family business at the time, was one of the conference sponsors—a tiny detail that felt symbolic of how intimate and pioneering this world still was. We were on the front edge of something that felt profoundly right.
I was immediately drawn to the Functional Medicine Timeline — a methodology that carefully maps a patient’s entire life history to understand how they arrived at their present state. This wasn’t 15 minutes of rushed questions. It was an unfolding. A respectful excavation of each woman’s story.
It was a system built for listening.
And it’s a system I still use today.
There’s a beauty to that ritual—when it’s applied in the right context.
I Opened My Own Practice — And Started to See the Limits
Shortly after my IFM training, I opened my own practice. And it came naturally. The model of functional medicine fit beautifully with my midwifery roots: listening, integrating, and making connections across systems.
For women in their 20s and 30s, functional medicine often worked well on its own. The protocols helped stabilize gut health, reduce inflammation and optimize early signs of imbalance.
But as I began seeing more women in their 40s and 50s, the pattern shifted.
I saw women who had done everything “right.” They had committed to elimination diets, cycled through endless supplements, followed intricate detox protocols, and shelled out thousands of dollars on stool tests, hormone panels, and micronutrient assessments.
And yet, they were still struggling.
For many, they were actually worse off—more depleted, more restricted, more confused.
And that’s when the blind spot revealed itself.
The Functional Medicine Blindspot
For women in midlife, ovarian hormone decline isn't an accessory issue. It’s central.
And yet, the functional medicine world tends to approach midlife women through the same lens they apply to any patient: gut dysbiosis, toxin overload, adrenal dysfunction, food sensitivity, methylation issues, detox pathways.
There’s some truth in these things, of course. But without acknowledging that falling estrogen and progesterone are driving much of this dysfunction, women are left chasing protocol after protocol that never fully restores them.
They are led to believe that if they just meditate more, restrict harder, detox longer, supplement better — the answers will come. And when they don’t feel better? They internalize the failure.
"I must not be doing enough."
This is where functional medicine unintentionally joins conventional medicine in failing women. Not because it's wrong, but because it's incomplete.
The Four Places Functional Medicine Misses Without the Hormone Lens
In my practice, I kept seeing the same four domains where functional medicine protocols were failing my midlife patients:
Autoimmune Disease
Estrogen plays a crucial role in immune modulation. As hormones decline, the risk of autoimmune disease rises — especially thyroid disorders, rheumatoid arthritis, and lupus. Functional medicine often focuses on gut health and inflammatory triggers, but misses how profoundly ovarian hormones modulate immune function.Gut Health
Declining estrogen impacts gut motility, barrier integrity, and the diversity of the microbiome. You can treat SIBO or dysbiosis all day long, but if you don’t address the hormonal undercurrent, it often returns.Mental Health
Estradiol is deeply tied to serotonin, dopamine, and GABA pathways. Mood instability, anxiety, and irritability in midlife are not simply stress responses — they are often biochemical. Functional medicine leans on adaptogens, meditation, and GI repair, but these rarely touch the true driver.Metabolic Dysfunction
Central weight gain, insulin resistance, rising blood sugars, poor sleep, and cortisol dysregulation are classic consequences of falling estrogen. Functional medicine attempts to address this through adrenal support, intermittent fasting, or elimination diets — but without hormone optimization, results remain limited.
Why So Many Women Are Drawn to Functional Medicine — And Why It Still Fails Them
Here’s what I want to say most clearly: women who believe there must be more are absolutely right.
They’re right to question conventional medicine's shallow offerings — the birth control pill, a progesterone capsule, or a patch handed over in a seven-minute appointment.
Functional medicine offers something powerful: time, attention, a promise to investigate. And that draws smart, intuitive women who know that they deserve better.
But what often happens is that they end up on the functional medicine merry-go-round: restrictive elimination diets, endless supplement protocols, detox after detox, more testing, more stool panels, more gut mapping.
And still under-replaced hormonally.
They come seeking depth — and instead find themselves exhausted, restricted, and still not well.
The Marriage That Actually Works
This is the heart of why I founded Aurelia.
Because medicine for midlife women should be the marriage of these two models.
It isn’t functional medicine or modern hormone science. It’s both — intelligently integrated.
At Aurelia, we use functional medicine’s depth where it belongs: in gathering history, in honoring nuance, in personalizing care. But we root all of it on a stable hormonal foundation because for women in their 40s and 50s, that’s where true restoration begins.
This is where 80% of our energy goes: circadian rhythm and light exposure, restorative sleep, movement that supports resilience, whole foods — not restriction, but nourishment, adequate protein and fiber intake, nervous system regulation, hormone optimization.
Do we use supplements? Yes.
Do we support methylation, detox, and gut health? Absolutely — when it's appropriate.
Do we believe there’s a place for alternative therapies? Without question.
But these are adjuncts. They are the finishing touches — not the foundation.
There are always outliers: complex cases involving Lyme, mold, or chronic infections may require more aggressive functional medicine protocols. But for most women? This integrated approach is where true healing lives.
What I Wish I’d Known in 2019
I still have tremendous respect for functional medicine. But I now understand that it is not enough on its own for women navigating the hormonal transition of midlife.
Had I known this earlier, I could have spared so many women — including myself — years of unnecessary protocols, expense, restriction, and frustration.
If you’ve felt like you’ve done everything “right” and still aren’t well — it’s not your fault. You haven’t failed. You’ve simply been handed an incomplete framework.
The solution isn’t to work harder. It’s to work smarter. To start with what’s foundational. To optimize hormones first, and build from there.
Is This Model Right for You?
I’ll be honest: this approach isn’t for everyone.
Some women will always prefer the simplicity of the conventional model — symptom, prescription, done. And if that feels safe and sufficient, that’s okay.
But for the woman who wants excellent instead of just “okay” — for the woman who wants to feel strong, vibrant, and deeply well — there’s a model designed for you.
That’s the work we do at Aurelia.
And we’d be honored to walk that path with you.