Perimenopause isn’t a syndrome to treat. It’s a complex, shifting transition that most women in their 40s are already navigating, whether they realize it or not. For practitioners working in functional medicine, failing to recognize and address the nuances of this phase can mean missing the real root of your clients’ symptoms.   In this episode, Tracy Harrison lays out five critical practitioner blind spots that lead to frustration and subpar outcomes. She challenges the idea that a fixed protocol can support women through perimenopause, reminding us that the only constant in this life stage is change. Hormones don’t decline in a straight line. Progesterone drops early and steadily, while estrogen tends to spike and swing before it ever goes down. This hormonal chaos can trigger anxiety, insomnia, mood swings, migraines, and even histamine-related issues that are too often misdiagnosed or ignored.   Tracy explains how common symptoms such as poor sleep, bloating, mood instability, hot flashes are often driven by overlooked mechanisms like GABA depletion, serotonin fluctuations, or impaired histamine clearance. She breaks down why alcohol can sabotage sleep and worsen hot flashes, why estrogen dominance is more common than we think, and how mindset and chronic stress directly influence hormone symptoms through the nervous system.   This episode is a call to meet women where they are, not with a standard protocol, but with a dynamic, personalized approach that accounts for the biochemical, emotional, and environmental complexity of perimenopause. If you want to truly support midlife women, you need more than hormone labs and supplements. You need to understand the full picture, and be prepared to shift with it.   Episode Breakdown: 00:00 Understanding Perimenopause: A Natural Transition 05:02 Why Protocols Fail in Perimenopause Care 08:06 How Progesterone Drop Triggers Mood and Sleep Issues 11:22 Alcohol’s Hidden Role in Anxiety, Insomnia, and Hormone Disruption 12:29 The Overlooked Link Between Histamine and Perimenopause Symptoms 16:21 Estrogen Dominance in Early Perimenopause: What Practitioners Miss 21:48 The Estrogen-Serotonin Connection and Its Impact on Mood 26:10 What Really Causes Hot Flashes and Night Sweats 30:00 How Stress Hormones Worsen Perimenopause Symptoms 32:09 Why Mindset and Thought Patterns Matter in Symptom Management 33:45 Partnering with Patients Through Perimenopause   Links Take SAFM’s 10 CME course - the Essential Gut Deep Dive: https://schoolafm.com/gut-course Get weekly Clinical Tips in your inbox: https://schoolafm.com/clinical-tips  Learn more about SAFM’s practitioner training: https://schoolafm.com/our-program Subscribe to our Youtube channel: https://www.youtube.com/@safmchannel Access daily quick tips on Facebook: http://www.facebook.com/AppliedFunctionalMedicine/  Podcast production and show notes provided by HiveCast.fm