Perimenopause: When to See a Doctor and What to Expect From Functional Medicine Care
You’re eating clean, trying to manage stress, maybe even squeezing in extra workouts—but the scale won’t budge. Your mood swings between “I’ve got this” and “I can’t do this anymore.” Nights are restless, mornings feel heavy, and the belly fat that wasn’t there a year ago suddenly won’t leave.
Sound familiar? You’re not lazy, and you’re definitely not imagining it. For many women, perimenopause sneaks in years before menopause itself, and the symptoms are often dismissed as “just stress” or “getting older.” But weight gain, fatigue, and mood changes aren’t just random—they’re your body asking for help.
We’re Dr. Erin Hendriks and Dr. Maricela Castillo MacKenzie, the founders of Elle MD, a functional medicine and medical weight loss clinic based in Royal Oak, Michigan. We help women uncover the real reasons behind their symptoms—balancing hormones, healing the gut, and restoring metabolism so they can finally feel like themselves again. We also offer
If you’ve been dismissed, told your labs are “normal,” or feel like your body is working against you—this guide will help you understand what’s happening and what to do next.
Understanding Perimenopause Symptoms That Can Affect Your Weight
Perimenopause isn’t just about missed periods or hot flashes. It’s a hormonal transition that affects nearly every system in your body—including how you burn fat, manage stress, and sleep.
How Sleep, Mood, and Cravings Are Linked to Hormonal Imbalance
One bad night of sleep can make anyone cranky, but during perimenopause, disrupted rest becomes the norm. Low progesterone makes it harder to stay asleep, while fluctuating estrogen can trigger night sweats. Poor sleep raises cortisol (your stress hormone), making you crave sugar or carbs just to keep your energy up.
And it’s not “just stress eating”—it’s chemistry. When your nervous system is in overdrive, your body looks for quick fuel, which leads to blood sugar spikes, afternoon crashes, and even more cravings. It’s a vicious cycle that many women mistake for “lack of willpower,” when it’s really a hormonal feedback loop.
Estrogen Dominance, Cortisol Spikes, and the Belly Fat Connection
If your jeans are feeling tight around the middle, you’re not alone. Perimenopause often brings estrogen dominance—too much estrogen compared to progesterone. This imbalance can increase fat storage around the hips, thighs, and especially the belly.
Add chronic stress to the mix, and cortisol pushes your body into survival mode, telling it to hold on to every calorie “just in case.” Even if you’re eating clean, this combination keeps belly fat locked in place.
When Gut Health and Inflammation Quietly Stall Weight Loss
Your gut isn’t just for digestion—it’s where hormones are processed and detoxed. If you have gut inflammation, constipation, or undiagnosed leaky gut, estrogen can build up instead of clearing properly. This leads to bloating, mood swings, and stubborn weight that won’t move no matter how much you exercise.
If this sounds familiar, it’s not your fault—and it’s not “just aging.” Your gut may be the missing link between your hormones and your metabolism.
What Are the Red Flags That It’s Time to See a Doctor?
Some perimenopause symptoms are annoying but manageable, while others are a sign that your body needs help now.
You should reach out if you notice:
- Unexplained weight gain despite consistent diet and exercise
- Fatigue that doesn’t improve even with more sleep
- Cycles that are suddenly irregular, heavier, or longer
- Mood swings, anxiety, or brain fog that make daily life harder
- New symptoms after stopping birth control or postpartum
Why many women struggle to get answers
Here’s the frustrating truth: many conventional doctors still dismiss perimenopause symptoms as “just stress” or “what happens with age.” Basic labs often come back “normal,” leaving women feeling unheard and confused.
If this sounds like your experience, it’s time to find a specialist who looks at the full picture—not just whether your estrogen level is “in range.”
What Doctor Should You See for Perimenopause and Weight Gain That Won’t Budge?
Not all doctors approach perimenopause the same way, and choosing the right one can make all the difference.
What Makes a Great Perimenopause or Hormone Doctor for Weight Management
The right doctor doesn’t just hand you hormones and send you home. They:
- Listen first, prescribe second. Your weight gain and fatigue aren’t “just aging,” and your story matters as much as your labs.
- Run advanced testing. Full thyroid panels, cortisol mapping, and gut testing help uncover hidden blocks to weight loss.
- Support your gut and liver first. If your body can’t detox hormones properly, even the best hormone therapy won’t work.
- Customize your care. No cookie-cutter diets or one-size-fits-all hormone plans—your body deserves more than guesswork.
If your doctor isn’t connecting all these dots, it might be time to look for one who does.
Can a Doctor Help You Lose Weight During Perimenopause? (Short Answer: Yes—But That’s Not the Goal)
The truth? Weight loss shouldn’t be the first goal—it should be a side effect of healing. Perimenopause weight gain is rarely about eating too much or exercising too little. It’s about hormones, gut health, stress, and metabolism working against you.
Why Conventional Weight Loss Advice Doesn’t Work for Hormonal Weight Gain
If you’ve tried cutting carbs, eating less, or pushing harder at the gym, you’ve probably noticed it doesn’t work the same way it used to. That’s because your body isn’t ignoring your efforts—it’s protecting you. Chronic calorie restriction can increase cortisol, worsen insulin resistance, and actually make you store more fat, not less.
During perimenopause, your body needs balance, not punishment. Until hormones and inflammation are addressed, weight loss will feel like an uphill battle.
How Functional Medicine Approaches Weight, Hormones, and Metabolism Differently
Instead of asking, “How do we make you lose weight?” functional medicine asks, “Why is your body holding onto it?”
We focus on:
- Gut healing – Because inflammation and poor estrogen detox slow metabolism.
- Blood sugar regulation – Stable insulin levels reduce fat storage and cravings.
- Nervous system support – A calm body burns fat more efficiently than one stuck in fight-or-flight.
- Hormone balance – Addressing estrogen dominance, thyroid function, and cortisol before cutting calories.
When your body feels safe, weight loss happens naturally—without extreme dieting.
When Hormone Therapy Helps
Hormone therapy can be life-changing for some women, especially if hot flashes, poor sleep, or mood swings are severe.
At Elle MD, we often spend weeks or months preparing your system—supporting detox pathways, calming cortisol, and balancing blood sugar—before introducing hormone therapy. That’s how we turn it from a band-aid into a true solution.
The Best Blood Tests for Perimenopause Weight Struggles
Typical testing includes:
- TSH (thyroid-stimulating hormone) – But without Free T3, Free T4, or Reverse T3, you won’t see if your thyroid is truly slowing your metabolism.
- Basic estrogen and progesterone levels – Without understanding how your body is metabolizing them, estrogen dominance can go unnoticed.
- Fasting glucose – But no insulin testing, which means early insulin resistance often gets missed.
The Role of testing Insulin, Cortisol, Thyroid, and Estrogen in Weight Retention
Perimenopause weight gain often comes down to four key players:
- Insulin – High levels signal your body to store fat, especially around the belly.
- Cortisol – Chronic stress raises this hormone, locking in fat as a survival response.
- Thyroid – Sluggish thyroid slows calorie burn and energy production.
- Estrogen – When not properly detoxed, it builds up, causing bloating, mood swings, and stubborn fat storage.
If you’re only testing one or two of these, you’re missing the big picture.
How Functional Medicine Testing Reveals the Full Hormone + Metabolism Story
At Elle MD, we go beyond basic labs to run:
- DUTCH hormone testing – Shows not just levels, but how your body processes estrogen, progesterone, and cortisol.
- GI-MAP gut testing – Identifies gut inflammation and imbalances affecting hormone detox.
- Comprehensive thyroid panels – Including Free T3, Free T4, Reverse T3, and antibodies for autoimmune thyroid issues.
- Fasting insulin + glucose – Detects metabolic resistance before it turns into diabetes.
This isn’t guesswork—it’s about connecting the dots between your labs and your symptoms.
Why More Women Choose Elle MD for Perimenopause Weight Support
At Elle MD, we’ve worked with hundreds of women who were told to “just try harder” when their bodies were actually begging for support.
Personalized Hormone Care That Supports Real Weight Loss—Without Crash Diets
We don’t believe in punishing your body to get results. Instead, we design care plans that rebalance your hormones, stabilize blood sugar, and improve energy—so weight loss happens naturally.
A Gut-First, Root-Cause Approach to Midlife Metabolism
Your gut health sets the stage for everything—hormone balance, metabolism, and even mood. By reducing inflammation and improving detox pathways, we help your body feel safe enough to finally let go of extra weight.
(Want to understand how hormones and weight connect? Check out our blog:Can hormone therapy help with weight loss? What women need to know.)
If you’re feeling stuck now, waiting won’t make it better. The earlier you address perimenopause changes, the easier it is to rebalance your hormones and metabolism. You deserve to feel like yourself again—don’t wait until symptoms take over. You deserve care that listens, connects the dots, and finally helps you feel at home in your body again.
Explore our Menopause weight management services and book your consultation today. The sooner we uncover what’s really going on, the sooner you can start feeling like yourself again.
*AI Disclosure:
This content may contain sections generated with AI with the purpose of providing you with condensed helpful and relevant content, however all personal opinions are 100% human made as well as the blog post structure, outline and key takeaways.
* Affiliate Disclosure: Some of the links on www.elle-md.com may contain affiliate links meaning that we will get a commission for recommending products at no extra cost to you.
*Blog Disclaimer: Please note that reading our blog does not replace any health or medical advice consultation. Read our blog disclaimer here.
Meet the Drs.
Dr. Hendriks and Dr. Castillo MacKenzie are board-certified physicians, female, specialized, with over 10 years of experience.
Elle MD started after practicing in a traditional primary care setting together for over a decade. We grew frustrated with the current healthcare model, which places no emphasis on addressing the root cause of chronic disease. A lot of times, conventional care doesn’t even promote overall wellness!
We founded Elle MD in Royal Oak, MI, with a vision of providing this care in a compassionate and personalized way.
Download your free guide
