What if the most powerful shift in how we practice medicine starts with one person deciding to do it differently? Aviva’s story is that kind of shift. Long before she ever sat in a medical classroom, she had already built a life as a midwife, herbalist, and mother of four who was deeply embedded in her community. Then, in what most of us would consider the busiest, most demanding years of life - years that often overlap with perimenopause - she made a radical decision: she went back to school. Back into training. Back into the system she wanted to help change. Not because something was broken, but because she saw what was missing. That’s what makes this episode different. It’s about what happens when women get to reframe the perimenopausal transition as one of the most powerful, generative, expansive years of their lives. Instead of accepting the status quo, Dr. Aviva Romm built an entirely different way of seeing things - one that doesn’t reduce symptoms to problems, but places them in context. One that connects sleep, stress, nourishment, physiology, and even relationships into a bigger picture of health. You can feel that perspective ripple through the entire conversation. It gently challenges the idea that you need more interventions, more testing, more fixing, and replaces it with something both simpler and harder: paying attention, understanding what your body is asking for, and supporting it instead of overriding it. By the end, something shifts. You’re not just thinking differently about perimenopause - you’re thinking differently about what’s possible during this phase of life. And maybe, like Aviva did, you start to wonder: what could change if perimenopause wasn’t seen as the end of something, but the beginning of something else entirely? Clinical Takeaways from This Episode A root-cause, whole-person approach to perimenopause may support more sustainable outcomes. Perimenopause often includes symptoms like sleep disruption, mood changes, and cycle irregularities, and may benefit from a broader, individualized care approach rather than a single intervention (Santoro et al., 2018). Stress physiology and HPA axis patterns may influence how symptoms show up. Chronic stress is associated with changes in inflammatory signaling and neuroendocrine regulation, which may shape mood, immune function, and metabolic health (Russell, 2019). Sleep is foundational—and CBT-I is an evidence-informed place to start. Cognitive Behavioral Therapy for Insomnia (CBT-I) is supported by clinical evidence and may help improve sleep quality without medication in many individuals (Rossman, 2019). Connection and community are not “extras”—they’re part of physiology. Social isolation has been associated with increased mortality risk, which reinforces the importance of connection as part of whole-person care (Naito et al., 2023). Thoughtful, targeted lab testing supports better clinical decision-making. Strategic use of labs—guided by symptoms and clinical context—may reduce unnecessary testing and help clinicians focus on meaningful data. Guest Introduction Dr. Aviva Romm , MD, is a Yale-trained physician, herbalist, and midwife with over four decades of experience in women’s health. She has trained hundreds of clinicians in integrative and functional medicine and is the author of multiple bestselling books, including Hormone Intelligence and The Adrenal Thyroid Revolution . Her work bridges conventional and integrative medicine in a way that centers women and their paths to thriving. FAQ: Clinician & Patient Questions on Perimenopause and Integrative Care What symptoms are common during perimenopause? Perimenopause may include: Sleep disruption Mood changes Hot flashes or night sweats Changes in menstrual cycles These are part of a normal physiologic transition, though symptom severity varies. Dr. Aviva uses a whole-person, root cause approach to successfully manage many of these symptoms. (Crandall, 2023). What can I do if I’m struggling with sleep in midlife? Cognitive Behavioral Therapy for Insomnia (CBT-I) is a well-studied, non-pharmacologic option clinicians may consider (Rossman, 2019). It may also help to evaluate: Stress levels Blood sugar patterns Sleep habits and environment How does stress actually affect my health? Chronic stress may influence: Hormone signaling Immune and inflammatory pathways Mood and cognitive function These effects are mediated in part through the HPA axis and inflammatory signaling pathways (Russell, 2019). Key Moments from This Episode 02:30 – Aviva’s journey: from herbalist and midwife to Yale-trained medical doctor 10:41 – Going back to medical school as a parent: what it really takes 28:14 – Stress physiology and the root causes of chronic symptoms 32:58 – Reframing perimenopause as a transition, not a decline 35:17 – Building a real-world toolkit: sleep, nourishment, nervous system support 41:01 – Botanical medicine in practice: motherwort and lemon balm 57:28 – Hypervigilance, burnout, and how they show up in the body 01:17:18 – The Yerkes-Dodson curve: finding your optimal stress zone 01:19:41 – How to think about labs without overtesting Want to elevate your practice? This episode is sponsored by Fullscript , a comprehensive care delivery platform designed to support whole-person, integrative healthcare. Fullscript allows clinicians to streamline supplement dispensing, lab ordering, and patient education in one free, centralized system—helping reduce administrative burden while supporting clinical decision-making. For practitioners, Fullscript offers access to professional-grade supplements, evidence-informed protocols, and lab integrations that can support more efficient planning and follow-up. For patients, it provides a clear, organized way to receive recommendations, manage refills, and stay engaged in their care. The goal is not to replace clinical judgment, but to make it easier for clinicians to focus on what matters most: thoughtful, individualized patient care. Disclaimer The views expressed on this podcast are those of the hosts and guests and don’t necessarily reflect those of Fullscript or any affiliated organizations. This podcast is for informational and educational purposes only and is not intended to be medical advice. For your safety, always check with your doctor or healthcare provider before making changes to your health routine. Citations Crandall CJ, Mehta JM, Manson JE. Management of Menopausal Symptoms: A Review. JAMA. 2023 Feb 7;329(5):405-420. doi: 10.1001/jama.2022.24140. PMID: 36749328. Rossman J. Cognitive-Behavioral Therapy for Insomnia: An Effective and Underutilized Treatment for Insomnia. Am J Lifestyle Med. 2019 Aug 12;13(6):544-547. doi: 10.1177/1559827619867677. PMID: 31662718; PMCID: PMC6796223. Russell G, Lightman S. The human stress response. Nat Rev Endocrinol. 2019 Sep;15(9):525-534. doi: 10.1038/s41574-019-0228-0. Epub 2019 Jun 27. PMID: 31249398. Naito R, McKee M, Leong D, Bangdiwala S, Rangarajan S, Islam S, Yusuf S. Social isolation as a risk factor for all-cause mortality: Systematic review and meta-analysis of cohort studies. PLoS One. 2023 Jan 12;18(1):e0280308. doi: 10.1371/journal.pone.0280308. PMID: 36634152; PMCID: PMC9836313.