Natural menopause specialist, brighton, UK and worldwide, online
Finally, a practitioner who understands what’s happening to your body
Perimenopause and menopause aren’t just hot flushes. They’re complex hormonal transitions that affect every system in your body. I run the panels others skip and create care plans as individual as your biology.
Trusted by 200+ women · Average client age 47 · 98% report significant improvement
15+ Years
FUNCTIONAL MEDICINE EXPERIENCE
Full Lab Panel
54 biomarkers analysed
Root Cause
not just symptom management
THE 68-SYMPTOM PERI/MENOPAUSE QUIZ
Could what you’re feeling be perimenopause?
Most women spend years attributing their symptoms to stress, aging, or “just how things are.” This quiz helps you understand what your body may actually be telling you.
To be healthy in midlife, we need to think about peri/menopause differently
Less than a decade ago, most of us — me included — had barely heard the word menopause said out loud, let alone in public. Then suddenly it was everywhere. TV documentaries. Celebrity confessions. Campaigns. Podcasts. Supplement ads. Shining a light on menopause is, in principle, a good thing. But the framing of that light is the problem. And the message, however it is dressed, has been loud and clear: menopause is held in place by an oestrogen ‘deficiency’ model that says you are fragile by design.
I offer an alternative as a direct contrast — the Adaptive Model, grounded in evolutionary biology, anthropology, evidence-based science and a decade of clinical observation, which says menopause is not a failure but a designed transition into a different biological configuration. The high-oestrogen state of fertile years was designed for fertile years — not for life. After that, the body moves into a different configuration, by design.
A post-menopausal woman is not a faulty younger woman. She is a different biological design, doing what she was always coded to do.
Two models, same body.
Here is what each one says.
THE DEFICIENCY MODEL
What you’ve been told
Your body has failed
Your ovaries have stopped working. You are running out of oestrogen.
You need HRT
Pharmaceutical oestrogen replacement is the responsible choice.
Your symptoms are inevitable
Hot flushes, brain fog, joint pain are evidence of what’s missing.
No HRT = suffering
Going without is either suspicious, ideological, or naïve.
THE adaptive MODEL
What biology shows
You have adapted
Ovarian retirement is the trigger for 3 biological shifts to come online.
You are building something new
The brain switches fuel sources, tissues take over local oestrogen production and your emotional state transitions.
Symptoms = compensation lag
Symptoms show where the new system needs support.
No HRT = default
Most women throughout human history reached this stage and lived decades beyond it in health.
Menopause has succeeded for 1.5 million years
Evolution does not preserve biology that leads to half the population being too sick to function. The long post-reproductive years exist because women living well past menopause are part of the reason humans are still here — shaping communities, holding knowledge, preserving and shaping culture, raising and supporting younger generations, freeing daughters to raise more children at shorter intervals. We are not a glitch in the system. We are part of what made the system succeed.
Ancient
Anthropologists estimate that menopause is 1.5
million years old — older than agriculture, older than language, older than civilisation
itself.
Selected for
If menopause were a biological mistake, it would have been
bred out long ago. Instead, it has
persisted, written into the our human design.
Essential
Post-reproductive women carried memory, language,
ritual and food knowledge — the cultural infrastructure that allowed our species to endure.
If the design is so intelligent, why do we suffer?
The design held for one and a half million years. It held through ice ages, famines, migrations, plagues. 21st century life is the first environment menopause cannot function in. Relentless stress, broken sleep, ultra-processed food, chronic sugar and starch overload, chemical loads, invisible caregiving, social isolation.
The ancient code is still trying to run — but the the environment we now live in is radically, profoundly different from the one our physiology evolved to thrive in. Our hormones are still running an ancient programme, written for a world of whole foods, daily movement, bright days and dark nights, episodic stress, and tight-knit communities. Instead, they’re now being asked to operate in a world of ultra-processed diets, chronic stress, sleep deprivation, sedentary routines, endocrine disruptors, and social isolation. This is an environmental mismatch — it’s a fundamental rupture between our evolutionary design and reality.
And that rupture is where most menopausal symptoms are born.
Symptoms are signals — the body’s way of telling us that the world we inhabit no longer matches the one it was built for. Every hot flush, every sleepless night, every surge of anxiety or stubborn kilo of weight is part of a larger story: the story of how our environment has drifted away from our biology, and how our biology is struggling to keep pace.
Menopause is not the problem – the context is. Which means that the misery is optional, because when you change the conditions, the symptoms resolve. Menopause without HRT should be our default position, not a suspicious alternative.
Menopause is not the problem. The context is. Change the conditions and the symptoms resolve.
Can we dismantle the “broken woman” myth — the century-old story that says a woman past fertility is, by definition, a diminished woman? Can we stop deferring to people who do not live inside our bodies, telling us what our bodies are – or should – be doing?
Who gets to tell the story of your menopause? The answer you choose is not abstract. It will shape how you understand your symptoms. It will shape the decisions you make about treatment. It will shape the kind of health you build in the decades ahead.
NEXT · A DIFFERENT STARTING POINT
Peri/menopause begins not with what to replace, but with what to support.
Phases
Shifts
Menopause knowledge hub
Symptoms are the side effects of a transition under pressure
Perimenopause and menopause symptoms are not random – they reveal where and why your body is struggling, what is shifting beneath the surface, and why this transition can feel so confusing.
When the root causes are clear, symptoms can be fixed.
Symptoms are the side effects of the conditions in which the transition has to operate — nutrition, stress, sleep, detoxification, blood sugar balance, and the cumulative pressures of modern life.
Late perimenopause and menopause
The oestrogen shift:
Joint pain
Vaginal dryness and recurrent UTIs
Hair loss and chin hair
Acne
Breast tenderness
Thinning skin
The emotional shift:
From belonging to becoming
When peri/ menopause overlaps with complex hormonal conditions
Are you moving through perimenopause or menopause while also navigating other hormonal, inflammatory or autoimmune conditions that complicate the picture – including overlap with endometriosis, fibroids, PCOS or adenomyosis?
This is where functional medicine is uniquely placed to join the dots
Functional medicine is designed to identify what’s driving what, and design care that actually matches your needs.
1 in 10 women are affected by ENDOMETRIOSIS
FIBROIDS affect more than 40% of women
Adenomyosis can be missed for years
PCOS often changes, rather than disappears, in midlife
PMDD can intensify in the hormonal turbulence of perimenopause
For many women, HRT is not the simple solution it is made out to be.
Many women start HRT and find that, despite some changes, they don’t feel better. A significant number come off HRT and feel worse than before – as if menopause has started all over again, with no map to understand or resolve what is happening.
Perimenopause and menopause are shaped by nutrition, stress, sleep, detoxification, blood sugar balance and the cumulative pressures of modern life – so these experiences are not anomalies. They are signals that the transition is not working.
HRT overlays additional oestrogen on top of the metabolic shifts that are already underway.
In some women HRT relieves symptoms. In many, it pauses or distorts the transition the body was trying to complete.
That is why the useful questions are no longer “HRT or nothing?” but:
Meet your practitioner
Adapting to the changes that perimenopause brings can be hard, but this is where I am trained to help you
I’m Sandra Ishkanes, Functional Medicine Practitioner specialising in perimenopause and menopause. My support means you don’t need to figure it all out by yourself.
When I entered perimenopause, I was met with the same answer every woman hears. I knew immediately it wasn’t enough. Oestrogen declining is natural — but symptoms are not. They are signals that the transition needs support. And the answers go far beyond oestrogen because our biology is shaped by chronic stress, disrupted circadian rhythms, poor sleep, toxic overload, imbalanced microbiomes, and the particular modern curse of being simultaneously undernourished and overfed.
Over the last decade, working with hundreds of women and drawing on my background in molecular biology and taking in evolutionary biology, biochemistry and nutrition, I’ve refined an approach that gets to the real drivers of symptoms and resolves them.
If you’ve been told your results are normal and HRT is your only option, that conversation ended before it should have. Your symptoms are my clues. Your biology, history and lived experience are the evidence. My job is to find what’s actually driving this — and address it with precision.
This is not symptom management. It is root-cause resolution.
One-to-one consultations
Your peri/menopause is personal.
Your care plan to reverse symptoms should be too.
The symptom you experience depend on what you eat, how you sleep, how your nervous system is regulated, the state of your gut, and your blood sugar stability.
I offer one-to-one in-depth consultations to find your root causes and address them with precision: clear answers, a personalised protocol, and a route through perimenopause and menopause that fits your real life.
What happens at your consultation:
The first consultation is an in‑depth, 1:1 functional medicine deep dive that over 90 minutes investigates root causes of your symptoms and creates a personalised plan for you.
Which phase are you in?
Together we establish where you are in your transition — which phase of perimenopause, or post-menopause —because each phase has its own support needs.
Curious? Take the quiz
Functional testing
Functional testing identifies priorities and the gaps, imbalances, and underlying drivers that cannot be identified from symptoms alone.
A complete picture of where you’re at and why
The consultation reveals why your symptoms have the pattern they do and what is driving them. Not “it’s your oestrogen/progesterone/testosterone” but a complete biological picture, built around you. From that, we build your protocol together.
What your care plan includes:
I take the time to understand how your life actually works, so that every recommendation is realistic and specific to you: nutrition, supplements, and lifestyle changes built around your biology, your stage, and your circumstances. Every element is connected. Every recommendation has a reason. A complete protocol so you can get started straight away.
Personalised nutrition
A precise dietary framework built to support your metabolic state, your symptoms, and the specific shifts your body is navigating right now.
Targeted supplements
Only what your biology actually needs, at the right doses, in the right forms. Every supplement is tied to a specific finding.
Stress regulation
Hormonal balance cannot happen in a body under chronic stress. We work on the conditions your body needs to repair, regulate, and stabilise.
case studies
Clinically proven results within 4 weeks
Case studies with full histories, test results, protocols and step-by-step progress
BRAIN FOG · FATIGUE · POST-MENOPAUSE
Brain fog in menopause cleared and all symptoms reduced by 85% in 8 weeks
Linda, 59
Linda arrived with severe brain fog and low energy affecting her work and daily life. We mapped her metabolic patterns, addressed insulin and thyroid drift, and built a brain-fuel protocol. By week 8 her energy was back and the fog had cleared.
“I finally have a roadmap. For the first time in years, I know what my body needs — and why.”
HOT FLUSHES · NIGHT SWEATS · struggling on hrt
Severe peri-menopausal symptoms despite HRT reduced by 80% in 4 weeks
Helen, 48
Helen came to clinic having already tried HRT. Her hot flushes and night sweats were severe. We worked on the metabolic and inflammatory roots driving the vasomotor symptoms and supported the intracrine system directly. By week 4 her symptoms were down 80%, she was able to come off HRT without any problems, and she continued to be well without it.
“I was told there was nothing else to try. There was.”
in their own words
They reached out, and found the root cause, not another script
BEYOND THE HRT DEFAULT
“Having guidance that doesn’t automatically lead to HRT, but instead looks at the whole picture of health, has been incredibly valuable.”
I
Ida F.
Nature connection facilitator
via Google
back in control
“Thank you Sandra. You have helped me get back in control of my life. No exaggeration. This has set me on a course for health for the rest of my life.”
D
Danielle B.
CEO Black Minds Matter UK
via Google
trusted with family
“Absolutely mind-blowingly good. Patient, responsive, open, thoughtful. I’ve already suggested my daughters talk to her.”
C
Caron B.
CEO Charity Finance Group
via Google
I felt better almost within a week, and 4 weeks later all my symptoms were almost gone. I came off HRT and my vitality is back. Transformative.
Heidi B.
Perimenopause symptoms reversed
via Google
100+
women
supported
10+
years in
clinical practice
4
weeks to
first results
1:1
every
consultation
how it works
A clear plan. A personalised protocol. Quick results.
My functional medicine approach focuses on finding the root causes of your symptoms, then using nutrition, supplements, and targeted lifestyle changes to help restore balance and improve how you feel.
01
Book a discovery call
30-minute phone call. We talk through your symptoms and history. You get my initial assessment of where the root causes lie — and whether this approach is right for you.
02
Consultation + your protocol
A 90-minute deep dive into your biology, history, and goals. You’ll leave with a clear understanding of what may be contributing to your symptoms, along with a personalised protocol covering nutrition, supplements, testing, and lifestyle.
03
Results within 4 weeks
Most women notice meaningful improvement within 4 weeks. From there, the focus is on resolving symptoms and building long-term resilience, including brain, bone, and cardiovascular health.
