Dr Michelle Leary

For the first time in modern history, menopause is stepping out of the shadows and into real conversation. Podcasts, books, research funding, group chats, late-night voice notes between friends — women are finally talking about it openly. And as someone in my 40s, I have to say, I love being a woman in this era.

And I’ll be honest — there’s something deeply empowering about understanding what your body is doing in this phase of life. Not fearing it. Not catastrophizing it. But actually getting curious about it.

Because once you understand the physiology, the mystery fades. And in its place, you get context.

Learn more on the blog! https://drmichelleleary.com/menopause-what-is-it-really/

Menopause: What Is It, Really? Menopause isn’t a sudden hormonal cliff. Explore the science of ovarian aging, perimenopause, progesterone loss, estrogen fluctuations, and how to understand this biologic transition with clarity and confidence.

If your patient been doing everything “right” and still not getting the results they hoped for, I want you to hear this: the problem may not be what they’re doing — it may be what’s going undetected.

Any pathological process in the body can potentially impact the health of the egg or s***m, but for women, the stakes are simply higher. Untreated health conditions such as PCOS/PMOS, endometriosis, Hashimoto’s thyroiditis and hypothyroidism, undiagnosed celiac disease, and vitamin D deficiency can all contribute to subfertility or infertility depending on the extent of the disease process. In the case of PCOS/PMOS, women may not ovulate at all, making natural conception impossible. Endometriosis may lead to inflammation and scarring and can contribute to tubal dysfunction or occlusion, making fertilization difficult.

These patients aren’t failing their fertility journey — they’re being failed by a workup that hasn’t gone far enough. When a patient presents with subfertility and no clear explanation, that’s not the end of the diagnostic conversation. That’s where it should begin. As clinicians, we have the tools to look deeper. The question is whether we’re asking the right questions.

Michelle Leary, ND, IMFCP

One of the most important factors in fertility is, without question, the health of the egg. Don’t get me wrong—s***m health is mission critical, and male factor infertility is real. But by definition, the faster, more motile s***m are more likely to reach the egg. (Nature is rude.) Still, s***m DNA fragmentation and chromosomal abnormalities can contribute to infertility and early pregnancy loss.

In most cycles, one egg is released. If that egg is chromosomally abnormal, that cycle will not result in a healthy full-term birth. There is significant controversy in reproductive endocrinology about whether you can “increase egg quality.” The reason is we know, with a very high level of certainty, that egg quality declines with age—especially via increased aneuploidy risk. This, combined with insulin resistance, PCOS, metabolic syndrome, inflammation, nutrient deficiencies, and environmental exposures can contribute to challenges becoming and staying pregnant.

There are animal studies and human trials (particularly in IVF settings) suggesting that certain supports—like Coenzyme Q10—may improve some markers of oocyte/embryo quality, though results vary and data are not uniformly conclusive. Vitamin D status has also been associated with certain fertility outcomes, particularly in assisted reproduction and in the context of immune/endometrial receptivity. Glutathione-related pathways (oxidative stress defense) are biologically relevant to oocyte health, though direct clinical outcomes data are still evolving.

Quick clarification: egg quantity (ovarian reserve) cannot be meaningfully increased by fertility drugs or supplements. What fertility medications can do is recruit and mature more follicles in a given cycle—helpful for assisted reproduction—but they do not create new eggs or reverse ovarian aging. DHEA is sometimes used in diminished ovarian reserve protocols and has mixed evidence; it may influence response in some IVF populations, but it is not accurately described as “increasing egg quantity” in the sense most people mean.

Michelle Leary, ND, IFMCP

PMS and PMDD are often misunderstood as simply “hormone problems.” The reality is more nuanced—and more clinically important.

The strongest and most prevailing theory suggests a combination of predisposition to anxiety or depressive symptoms, coupled with the effect estrogen and progesterone have on the serotonin, γ-aminobutyric acid (GABA), and dopamine systems.

Serotonin, GABA, and dopamine are critical neurotransmitters that can either hinder or enhance mood. During the luteal phase, changes in these sensitive systems can disrupt, antagonize, or augment mood stabilization.

This is why symptoms are not “just in your head”—they are rooted in neuroendocrine physiology.

When symptoms become more severe, it’s important to look deeper at underlying patterns. These patterns are signals—not diagnoses to ignore.

From a functional medicine perspective, the goal is not to suppress symptoms, but to understand why these neurohormonal and inflammatory shifts are occurring in the first place.

Because when you address the root cause, you change the experience of the cycle—not just manage it.

Fertility looks simple from a distance—but when you zoom in, it is one of the most complex biological processes in the human body. Conception requires precise brain-to-ovary signaling, healthy egg and s***m development, chromosomal integrity, ovulation, fertilization, implantation, and a stable hormonal environment. Conditions like PCOS, endometriosis, Hashimoto’s thyroiditis, undiagnosed celiac disease, insulin resistance, and vitamin D deficiency can subtly shift this terrain—often in ways that routine hormone testing alone doesn’t reveal.

Read more on the blog! ➡️ https://drmichelleleary.com/why-fertility-is-more-than-hormones/

Michelle Leary, ND, IFMCP

Excited to share that I’ll be presenting a webinar this Wednesday!

As functional medicine clinicians, we talk a lot about the brain — but how often do we zoom in to the organelle level?
Mitochondria aren’t just the powerhouse of the cell. In neurons, they are central regulators of cellular stress response, repair signaling, and long-term cognitive resilience. When mitochondrial bioenergetics falter, the downstream effects on brain cell function are profound — and increasingly, the research is giving us clinically actionable targets.

In this webinar, I’ll be walking through:
→ Mitochondrial dysfunction’s role in brain and cognitive decline
→ Clinical implications of targeting mitochondrial renewal pathways
→ Emerging preclinical data on how Urolithin A may support brain againg

Would love to see colleagues there
🔗 register here! f09f7f7d-6986-4149-bb11-40516b9e4fd3@4f2a9ea4-e014-4389-9ac5-7a060d837a29" rel="ugc" target="_blank">https://events.teams.microsoft.com/event/f09f7f7d-6986-4149-bb11-40516b9e4fd3@4f2a9ea4-e014-4389-9ac5-7a060d837a29

🧠 The Central Role of Mitochondria in Brain Longevity
📅 Wednesday, April 22 | 11:00 AM PST

What is happening at the level of the mitochondria?

These organelles are far more than energy producers. They regulate inflammation, immune cell differentiation, insulin signaling, lipid metabolism, and neuronal survival. When mitochondrial function is compromised, the downstream effects are systemic — and they look like the chronic disease patterns we see every day in practice.

Cognitive decline, cardiovascular disease, metabolic syndrome, chronic inflammation — the research increasingly points to a shared bioenergetic foundation.

This is why I believe mitochondrial medicine deserves a seat at the table in every functional and integrative practice.

Michelle Leary, ND, IFMCP

Dysmenorrhea is defined as pain associated with menstruation.

It is categorized into two types:
✨ Primary dysmenorrhea – painful me**es without a structural cause
✨ Secondary dysmenorrhea – caused by an underlying medical condition

Primary dysmenorrhea is very common and typically begins 1–2 days before menstruation and lasts 2–4 days.

There is a normal rise in pro-inflammatory compounds within the uterus prior to menstruation that lead to uterine muscle contraction. Because of this, it is accurate to say that some discomfort with menstrual cycles is normal.

Abnormal menstrual pain is subjectively defined as severe, debilitating pain that interferes significantly with daily activities such as attending work or school.

But here’s the key distinction: just because something is common does not mean it is optimal. Severe menstrual pain is a signal — not something to normalize or ignore.

In functional medicine, we look deeper at the root contributors, which may include hormonal imbalances, inflammation, or underlying conditions such as endometriosis or fibroids. Understanding your cycle provides insight into your overall health — not just your reproductive system.

Michelle Leary, ND, IFMCP

I am so grateful and honored to be an executive board member for PLMI!

Executive Board Member Highlight: Michelle Leary, ND, IFMCP

Dr. Michelle Leary, ND, IFMCP is a nationally recognized leader in functional and personalized lifestyle medicine. Having advanced neurology training and deep knowledge of multiple sclerosis, her expertise in complex chronic conditions blends perfectly with PLMI’s community.

Leary currently serves as the Director of Functional Medicine at Vida Integrated Health, as well as being a highly regarded Executive Board Member of PLMI.

Leary guides early adopters of artificial intelligence technologies in the integrative medicine field, such as physicians looking to enhance patient outcomes with innovative tools.

Did you know?

For more than five years, Dr. Leary has directed a collaborative residency program with the Institute for Functional Medicine, mentoring emerging physician leaders in integrative care!

See all our distinguished Executive Board Members:
https://plminstitute.org/leadership-and-executive-board/

“Irregular periods” is a term many women hear — and experience — but it actually encompasses many different conditions, definitions, and presentations.

Most women experience irregular menstrual cycles for at least a period of time prior to menopause. Certainly by the time she reaches menopause, she will likely have noted changes in her cycle from being “regular” to “irregular” for one reason or another.

Irregular periods encompass many different conditions, definitions, and presentations. Let’s begin by defining what is considered “normal” and work our way towards the confusing world of irregulars.

It is interesting to note that over 20% of women experience irregular menstrual cycles, but far fewer seek medical assessment.

In 99% of women, typical cycle lengths are 21-35 days apart between the 1st day of bleeding cycles with the vast majority of those occurring between days 24-35.

In the normal menstrual cycle there are three main phases; follicular, ovulatory, and luteal (check out my previous posts to learn more about each phase).

Michelle Leary, ND, IFMCP