What a Functional Medicine Approach Actually Looks Like
Functional medicine is a term that has been stretched to cover a great deal, including some things that deserve skepticism. This page sets out what it means in this practice, specifically, for perimenopause.
Dr. Massinople is a board-certified physician with over 25 years in clinical practice. What follows is conventional medicine done with more time and a wider set of questions, not an alternative to it.
What actually happens
A proper history first
Longer than you are used to. When symptoms started, what else was happening then, what you have already tried, what your cycle has been doing, how you sleep, what you eat, what you are carrying. The pattern usually sits in the history rather than in any test.
Testing that answers a question
Thyroid properly, not TSH alone. Ferritin as well as hemoglobin. Vitamin D, B12, HbA1c, fasting insulin, a lipid panel. More specialized testing when the history points somewhere specific.
What you will not get is a large panel ordered because it is available. Every test should change what happens next, or it is not worth running.
The foundations, in order
Sleep, blood sugar, protein, muscle, gut function, nervous system load. Not because these are gentle alternatives to treatment, but because hormone support works considerably better on top of them and considerably worse without them.
This is the part that takes time and the part that does most of the work.
Hormones, where appropriate
Discussed honestly, with the evidence as it actually stands rather than as either side of the argument prefers it. Hormone therapy helps a great many women. It is not right for everyone, it is not a substitute for the foundations, and it is not something to be talked into or out of.
Review and adjust
Perimenopause is a moving target over several years. What works at forty-four may need changing at forty-seven. This is ongoing care rather than a single consultation with a protocol attached.
What this is not
It is not a promise that every symptom resolves. It is not a reason to stop seeing your other doctors. It is not a shelf of supplements, and it is not a package sold on the basis that your labs are secretly abnormal.
If something needs conventional investigation or treatment, that is what should happen, and being told so is part of the service rather than a failure of it.
Who this suits
Women who have been told their labs are normal and know they are not well. Women who have several symptoms that nobody has connected. Women who have tried hormone therapy and are still not right. Women who want the time to work through it properly rather than in twelve-minute increments.
Two ways to work with Dr. Massinople: private one-to-one care, or the Elevated Foundations membership. See which fits, or read the full picture on perimenopause.
