Natural menopause specialist, brighton, UK and worldwide, online

Exhausted, Foggy, and Not Feeling Like Yourself in Peri/Menopause?

Your symptoms are loud signals that your metabolism and nervous system are struggling to adapt to your transition. As a molecular biologist, I run the testing others miss and create a precise roadmap that restores your natural energy and mental sharpness.

Meet Sandra

Molecular biologist turned functional medicine practitioner, with over 10 years supporting women through peri/menopause without HRT. If you want a natural route, or need a clinical roadmap to safely come off your HRT without symptom rebound, you’re in the right place.

Get to know me

One-to-one Consultations

Let’s look at your unique biology, your clinical history, and exactly where you are in your transition, then build a targeted protocol around it— delivering truly personalised, root-cause support for your full health.

Explore Consultations

Case Studies

“It’s like my brain energy has switched back on—I can think clearly and enjoy life again.” — Linda, 59, symptoms down 85% in 8 weeks by fixing her metabolic energy block.

How Linda reversed her brain fog

10+ Years

functional medicine experience

Full Lab Panel

54 biomarkers analysed

Root Cause

not just symptom maNAgement

Perimenopause and Menopause Can Feel Like a Mystery. They’re Not.

For decades, we’ve been told a dangerously simplistic story: your ovaries stop, your oestrogen levels plummet, and your body slowly grinds to a halt. It’s the “empty tank” theory of menopause, reducing a natural transition into a permanent medical deficiency. But this is myth, not biology.

Your body isn’t breaking down; it is executing a highly sophisticated biological upgrade designed for your longevity, resilience, and health span. Low oestrogen is not a mistake—it is the exact, healthy destination your body is designed to reach. A perimenopausal or menopausal woman is not a faulty younger woman; she is a completely different, highly intelligent biological design.

If the design is so intelligent, why do we suffer?

Because your hormones are running an ancient programme written for a world that no longer exists. Our biology evolved over 1.5 million years for Original Eve to thrive on whole foods, deep circadian sleep, natural movement, and close-knit communities. Instead, modern Burnt-out Eve is being asked to run in a 21st-century environment of ultra-processed diets, chronic stress, sleep deprivation, and relentless pressure.

Symptoms result from an evolutionary mismatch.

Every hot flush, sleepless night, surge of anxiety, or stubborn kilo of weight is not a biological malfunction, it’s a distress signal. It is a fundamental rupture between your evolutionary design and modern reality. Your body is sending alarm signals as symptoms because modern conditions are hijacking your natural transition.

It is not oestrogen that needs replacing. It is a nourished life.

Menopause is not the problem—the context is. And because the context is the problem, the misery is entirely optional. When you change the conditions, the symptoms resolve. That is why you can safely navigate this transition naturally, or transition off HRT without your symptoms returning. We don’t focus on what pharmaceutical hormones to replace. We focus on how to support your body’s built-in, ancient design.

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Hormonal
Phases
Metabolic
Shifts

Peri/Menopause knowledge hub

Peri/Menopause changes everything—from how you sleep to how you think. Brain fog, fatigue, or anxiety are the side effects of a transition under immense pressure.

How is your nutrition, blood sugar, stress, sleep, and liver detoxification? These are the foundations under which your transition has to operate. When these foundations fail, your symptoms flare—and no amount of external HRT can patch over those broken roots.

The symptoms are not random — they cluster in 2 hormonal phases and 4 metabolic shifts to reveal exactly which metabolic gateways are struggling. Once we isolate those patterns, they can be fixed.

Explore the articles below to discover why your body is not a mystery, how your systems can hold steady naturally, and how to safely navigate this transition from the metabolic roots up.

When your symptom pattern is clear, the route to healing is clear.
Peri/menopause explained
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Phase 1:
Early perimenopause

Early Perimenopause: The Progesterone Shift

Early perimenopause is defined by the Progesterone Shift — as ovulation becomes increasingly unreliable, the luteal phase produces no progesterone, creating oestrogen dominance that drives heavy periods, breast tenderness, anxiety, insomnia, and mood changes in women whose blood tests still appear normal. The five-lever protocol addresses the hormonal terrain directly rather than waiting for oestrogen to fall.
Read More Early Perimenopause: The Progesterone Shift

Typical challenges:

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Phase 2:
Late perimenopause and menopause

The Energy Shift

Declining ovarian oestrogen triggers a fuel change in the brain. You can reverse hot flushes, night sweats, brain fog, anxiety, heart palpitations, low mood, fatigue and weight gain by eating less carbohydrates to stimulate fat burning and ketone production.
Read More The Energy Shift

Typical challenges:

The Oestrogen Shift

Perimenopause triggers the shift in oestrogen production from the ovaries to your own tissues, built from adrenal DHEA. How well this local supply holds up — steady DHEA from the adrenals, and the iron and B vitamins the tissues need to convert it — shapes how heavily symptoms land, and it is where support can make the difference.
Read More The Oestrogen Shift

Typical challenges:

Peri/Menopause Knowledge Hub

THE 68-SYMPTOM PERI/MENOPAUSE QUIZ

Early perimenopause? Late perimenopause? Post-menopause?

This quiz helps you identify where you are in the transition and the root causes of your symptom pattern.

Take the quiz
quiz enhanced 2

Peri/Menopause knowledge hub

When peri/menopause collides with complex conditions, the effects can be severe.

This is exactly where whole-picture medicine matters most.
I have years of experience supporting women to live free of pain and anxiety, naturally.

Severe pain, nausea and bloating at menstruation, caused by inflammation from internal bleeding of uterine tissue, laid down during foetal development. Excess oestrogen and inflammatory foods make it worse.

The extreme pain and inflammation from the very first period can flare in early perimenopause when ovarian oestrogen starts spiking. Careful hormonal management can quieten the flares and resolve pain.

“I had been suffering with crippling period pains since my first period and nothing seemed to work. Since starting with Sandra I feel much better able to manage my life, work and activities when I have my period now – I don’t have to miss out. Seeing Sandra has changed my life.”

Endometriosis and perimenopause Managing Endometriosis

Adenomyosis consists of muscle knots in the uterus which can cause severe pain throughout the cycle and heavy bleeding; they are wounds that won’t heal. Root causes include uterine infections and oestrogen levels that are too high.

Adenomyosis – route to recovery

These silent benign tumours in/around the uterus are driven by high oestrogen levels and vitamin D deficiency.

Fibroids affect more than 40% of women in perimenopause and are a common cause of heavy bleeding. Stopping their growth and slowing the bleeding makes for an easier transition to menopause when they finally quieten.

“Controlling the flooding means I don’t have to worry about going out anymore”

Fibroids and perimenopause Fibroids – stopping the flow

What was once an evolutionary survival benefit is now causing havoc due to high testosterone driven by sugar and insulin. Intermittent periods, acne, weight gain, unwanted hair can improve in early perimenopause, but get worse in late perimenopause when oestrogen dropping magnifies insulin resistance.

“I asked Sandra to help me with PCOS problems I’d been struggling to manage for a few years.
Following her advice has resulted in a very marked improvement in almost all of the symptoms I was experiencing. I feel about 15 years younger, with far greater energy, far less pain and a sense of health that’s been missing for some time now. I’m now implementing her recommendations on a long term health plan. The future is bright!

PCOS explained

Premenstrual Dysphoric Disorder causes severe irritability, depression, or anxiety in the week or two before the menstrual cycle starts. Because women with PMDD are hyper-sensitive to normal hormonal shifts, the unpredictable midlife hormonal rollercoaster triggers severe anxiety, rage, and depressive symptoms more frequently, stretching the suffering across unpredictable parts of the cycle.

“Knowing what triggered the hormone imbalance and what I needed to do to balance it out again, was the biggest part of the jigsaw. Finally, I was able to take back control. I cannot thank Sandra enough for all of her help and input and would recommend her to any woman going through difficulties with a hormone imbalance.”

PMDD symptoms reversed – case study

Coming off the pill during perimenopause removes the artificial hormone safety net, often unmasking an underlying menopausal transition. Because the pill provides steady synthetic oestrogen and progestogen, stopping it can trigger an abrupt drop in oestrogen, leading to a rapid influx of hot flushes, night sweats, mood swings, and irregular cycles that the medication had previously suppressed. Advance preparation can make the process a breeze.

” I was surprised to find that being off the pill the regular back/neck pain I had been experiencing reduced dramatically. Since working with Sandra and developing a diet to suit me, my skin has been a lot clearer and I now have the knowledge and tools to make good decisions to support my body.”

Coming off the pill

PERI/Menopause knowledge hub

Wherever you are with HRT, I’ll meet you there.

HRT overlays 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

You want to avoid HRT

Whether for medical reasons or personal ones, there is real work we can do first — nutrition, gut health, stress physiology, targeted supplementation. Root-cause care means HRT doesn’t need to be the default option.

You can go through peri/menopause without HRT – and feel vibrant and confident in your health

Your HRT is not working and you want to come off

HRT in place, but symptoms unresolved or the side-effects are unacceptable. Coming off well is a process, not an event, and stopping abruptly can cause more problems.

Why is my HRT not working?

You’ve come off HRT and are struggling

Coming off — by choice or necessity — can feel like the ground moving twice. I can help your body find its own footing, so you can move forward in health and confidence.

Why have my symptoms come back after stopping HRT?

Book a Peri/Menopause Strategy call

Meet your practitioner

Adapting to the changes that peri/menopause brings can be hard, but this is where I am trained to help you

Hi, I’m Sandra Ishkanes

Functional Medicine Peri/menopause Specialist

BSc · MA · DipION · ANP MEMBER

I have a degree in molecular biology, clinical training in functional medicine and I am an expert in resolving the root causes of peri/menopausal health issues. I work like a health detective, where symptoms are my clues and poor health is my crime scene. I identify the root causes of unbalanced hormones and create solutions to optimise health.

Over 10 years of clinical experience

For over 10 years, I have been empowering women to take charge of their gynaecological health by providing education, resources, and personalised support.

My passion for problem solving means a success rate of over 90%

The functional medicine model provides a systems analysis framework within I can connect, understand and optimise all aspects of of your health, and it’s what I love to do.

Partnership, compassion and care

A safe and supportive environment means you can discuss your concerns and receive personalised care that meets your unique needs.

Meet Sandra
ONE-TO-ONE FUNCTIONAL medicine PERI/MENOPAUSE CONSULTATIONS

One-to-one consultations deliver peace of mind

Tangible physical and mental outcomes for your unique biology—grounded in science, not guesswork

  • A Sharp, Focused Brain
    We stop your mid-afternoon brain fog and concentration crashes by unblocking your liver’s ability to manufacture ketones. By clearing the metabolic jams that lock your brain out of its fuel supply, we provide your nervous system with the clean, post-reproductive alternative energy it is starving for.
  • Deep, Unbroken Sleep
    Say goodbye to the exhausting “wired but tired” loop and abrupt 3:00 AM awakenings accompanied by an anxious, racing heart. By stabilising your nighttime blood sugar, we shut down the emergency cortisol spikes your brain triggers when it runs out of fuel, allowing you to fall asleep naturally and wake up feeling restored.
  • Comfortable, Pain-Free Movement
    We cool down the systemic inflammation that causes morning joint stiffness and muscle aches. By correcting subclinical depletions in vital cellular cofactors like iron and Vitamin D, we reactivate the local tissue enzymes responsible for building collagen, hydration, and bone density from scratch.
  • A Responsive, Energized Metabolism
    Your body stops aggressively shunting blood sugar into stubborn midsection storage—what many call the “meno-belly.” We use a strategic nutrition framework to lower your baseline insulin blocks, allowing your cells to access stable energy throughout the day and helping your weight naturally stabilize.
  • Grounded Emotional Resilience
    We quieten the persistent, unprovoked hum of anxiety, sudden panic flashes, and flat moods. By optimising supporting your adrenal capacity, your nervous system regains a steady, calm baseline that daily stressors can no longer easily compromise.
  • Complete Control Over Your Health
    You stop guessing and stop outsourcing your well-being. We focus on activating your body’s built-in post-reproductive system, giving you the security and data-driven proof that your body can transition smoothly and thrive naturally on its own terms.
Consultations

Symptoms and Conditions I Specialise In

Hormonal transitions

  • Chaotic Perimenopause
    Unpredictable, short, or skipped cycles accompanied by wild mood spikes, sudden hot flushes, and erratic energy drops.
  • Heavy Bleeding & Flooding
    Extended periods, heavy flows, spotting, or passing large clots driven by anovulatory cycles and an unsupported uterine lining.
  • Complex Uterine Presentations
    Specialised non-hormonal support for women navigating fibroids, endometriosis and adenomyosis.
  • Post-Menopausal Vitality Gaps
    Restoring long-term health span, bone density markers, and energy reserves years after your final period.

Metabolic Mismatches

  • The Energy Drop
    Relentless daytime fatigue, heavy morning exhaustion, and the profound “menopause brain fog” that compromises your memory and focus.
  • Adrenal & Sleep Disruptions
    Chronic, unprovoked anxiety, sudden nighttime panic loops, and the “wired but tired” state that triggers abrupt 3:00 AM awakenings.
  • Connective Tissue & Local Clearance Issues
    Stubborn midsection weight gain (“meno-belly”), systemic joint pain, morning stiffness, rapid skin thinning, severe bloating, digestive changes, or recurrent UTIs and urogenital dryness.

HRT Transition Profiles

  • The Planned HRT Taper
    Women who have made the informed decision that they want to safely step down and come off HRT completely, requiring a rigorous biological protocol to prevent a symptom rebound.
  • HRT Contraindications
    Women who cannot medically take hormone therapy due to a history of hormone-sensitive health concerns and need an evidence-based, completely natural alternative.
Consultations
case studies

Clinically proven results start 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.”

Read Linda’s case study
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.”

Read Helen’s case study
how it works

Success starts with a plan

Linda, 59, achieved her dream of trekking a mountain, once we reversed her severe brain fog

01

Book a free 30 minute strategy 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

Have a consultation, follow 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

Start seeing results within 4 weeks

Start seeing meaningful improvement within 4 weeks. From there, the focus is on resolving symptoms and building long-term resilience, including brain, bone, and cardiovascular health.

book a Peri/menopause Strategy call
in their own words

Peri/Menopause support beyond the 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

Book a Peri/Menopause Strategy call

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

testimonials
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100+

women
supported

10+

years in
clinical practice

4

weeks to
first results

1:1

every
consultation

FAQs

Frequently asked questions

Yes. While oestrogen decline is a fact of menopause, the symptoms are driven by how your body handles that shift. Many of the most severe symptoms – hot flushes, brain fog, broken sleep – are signals that the brain is struggling to switch fuel sources as oestrogen drops. When we support that metabolic shift directly, alongside gut and adrenal function, the symptoms that were signalling the crisis resolve. This is what I see in clinic, repeatedly.

Yes — if you are open to coming off HRT, as a goal once your biology is steady. I do not provide support designed to help women stay on HRT long-term; that is not where my clinical work sits. Many of the women I work with came to me on HRT and prepare to come off well and to avoid a return of symptoms. If this direction of travel feels right to you, we are well-matched.

That uncertainty is very common—and it is not a reason to wait. Perimenopause can begin years before periods stop, and the metabolic shifts it triggers are often already well underway before a GP would consider a diagnosis. If you are noticing changes in sleep, mood, or cognitive clarity, the biology is already shifting. Waiting for certainty usually means waiting for things to get worse.

Most appointments are 10–15 minutes and focused primarily on symptom management via HRT. My initial consultation is a 90-minute deep dive focused on your full history and biology. Standard clinics aim to manage symptoms; my aim is to optimise your health by changing the biological conditions that are producing those symptoms in the first place.

Standard blood panels rule out disease; they don’t map a biological transition. They test a narrow range of markers at a single point in time. Many drivers of menopause symptoms—like hormone metabolism, adrenal function, or gut health—simply don’t appear in routine GP tests. “Normal” means nothing was flagged as pathological; it doesn’t mean the biological picture is complete. As a health detective, I look for the logic in the data that standard tests leave behind.

Most women notice meaningful change within 4 weeks—typically in energy, brain fog and sleep first. Almost all symptoms resolve within 8 – 12 weeks. I will give you a clear, honest picture of your timeline at your first consultation. I do not make promises I cannot keep, and I do not take on clients I do not think I can help.

The initial consultation is £365 (90 minutes) and follow-up sessions are £165 (45 minutes). I do not lock clients into fixed packages; the work continues only for as long as it is useful. I also offer payment plans for those with constrained budgets. Consider this an investment in a roadmap that finally makes sense of your body, rather than continuing to spend on “Band-Aid” fixes that don’t work.

Consultation fees do not include laboratory testing costs, which are paid directly to the lab. Blood testing is almost always required and highly targeted – I only recommend what is necessary to solve your specific “detective” case. Advanced tests (like the DUTCH test or microbiome mapping) range from £150 to £400 depending on the complexity of symptoms.

I clients online only. Using a secure telehealth platform, I provide the same level of deep-dive clinical support and functional testing analysis regardless of your location. You can access specialist menopause care from the comfort of your own home.

Smarter practitioner, superior care

“I walked away from my first consultation with Sandra full of energy, hope and motivation. Her knowledge and enthusiasm had bowled me over, and I set about immediately following her advice to the letter. The results were incredible. Even my GP was amazed.

Within just 4 weeks from starting my protocol my body had gone through a total reboot. I was, and still am, feeling great.”

Book a Peri/Menopause Strategy call

My approach is right for you if

  • You have several peri/menopausal symptoms that seem unrelated.
  • You’re taking HRT but still don’t feel well and want to explore a functional medicine route.
  • You prefer to avoid HRT and want a structured alternative rather than guessing.
  • Your routine tests have been reported as normal but you still feel markedly different.
  • You want to understand why your symptoms are happening, not simply suppress each one individually.
  • You’re prepared to make meaningful changes to nutrition and lifestyle where these are relevant.
  • You want an individual approach rather than a standard menopause protocol.
  • You are not committed to a vegan or vegetarian diet.
Book a Peri/Menopause Strategy call