Not every woman gets hot flushes, even with the same fall in oestrogen — and that is the clue to what actually drives them. A flush is produced by the brain’s temperature centre, but what…
The brain fog that starts in late perimenopause — losing words, forgetting why you walked into a room, reading the same line three times — has a specific, physical cause: the brain running short of…
The journey from early perimenopause to post-menopause is a series of biological shifts, each with a different hormonal driver, a different symptom cluster, and a different clinical need. Understanding which shift you are in is…
Make sense of the anger, the withdrawal, the unwillingness to keep performing, and embrace the nervous system reorganisation underneath that leads to emotional freedom.
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…
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…
Mainstream medicine is still working with a 1950s framework — one that treats oestrogen deficiency as the root cause of everything you’re feeling, which is why HRT makes sense for them. But there is one powerful dissenting voice.
Dr Nanette Santoro is a menopause scientist elected to the US National Academy of Medicine and chair at the University of Colorado School of Medicine. As lead investigator on the Study of Women’s Health Across the Nation (SWAN), she has followed more than 3,000 women aged 42–54 since the mid-1990s to understand the menopause transition and its consequences on women’s health. She has concluded that:
—Dr Nanette Santoro, lead investigator SWAN
In the last decade, the science of menopause has moved significantly. We now understand that symptoms are driven by far more than oestrogen decline — by metabolic shifts, nervous system load, inflammation, and the conditions in which this transition has to happen. Dr Santoro is clear: symptoms cluster together — hot flushes, brain fog, low mood, and broken sleep don’t arrive randomly. They share root causes. Which means they can be addressed at the root. My practice is built on that research.
If you’ve been told your symptoms are just low oestrogen — or that HRT is your only option — there is another way. It doesn’t matter where you are with HRT. The work is the same: your biology, your root causes, your protocol.
The discovery call is free, 30 minutes, and no obligation. Let’s have that conversation.
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Sandra Ishkanes Natural Menopause Specialist based in Brighton, serving clients worldwide via Online Consultations
BSc Molecular Biology (King’s College London) | DipION | Functional Medicine Practitioner
Registered member, Association of Naturopathic Practitioners (ANP) – the UK professional body for accredited naturopathic and functional medicine practitioners. ANP members hold accredited qualifications, carry professional indemnity insurance, and follow a strict code of ethics.
© 2026 Sandra Ishkanes · sandraishkanes.co.uk
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The information provided on this website is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. Sandra Ishkanes is a Functional Medicine Practitioner and Molecular Biologist, not a medical doctor. Always seek the advice of your GP or other qualified healthcare provider with any questions you may have regarding a medical condition or before making any changes to your diet, lifestyle, or supplement regimen—especially if you are currently taking prescription medication or HRT. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
