Is is Perimenopause or is it..

IS IT PERIMENOPAUSE — OR IS IT…?

Hot flashes. Poor sleep. Anxiety. Irritability. Brain fog. Fatigue. Changes in weight. Feeling suddenly less resilient than you used to. Changes in your cycle.

Sometimes, yes—it really is perimenopause. And sometimes it is not.

Perimenopause and menopause are really hot topics these days. I get it. This key event in a woman’s life as she transitions from her fertile to non-fertile years were hugely unresearched and ignored my medical research and our local doctors alike. So women suffered in silence, not knowing that some of their symptoms (but likely not all) were in part due to the big shift in hormones. BUThormones don’t operate in isolation. And many of these same symptoms can be influenced by other systems in the body which I think are too often ignored if you are a woman who happens to be in that 35-50 age range.

When I hit around 42 or 43 I noticed some bad shifts in my health. I was really tired and low energy, my hair was getting really, really thin, my nails which were always brittle, seemed to break if I touched something with the slightest force. My sleep had been getting progressively worse for the last 5 years or so. My digestion which off and on had caused me to suffer since my 20s, got worse.

I tested my hormones (both with conventional serum (not helpful)as well as DUTCH functional testing (super helpful). And while my progesterone was in perimenopause ranges and my symptoms suggested my sex hormones were playing a role, I suspected more was going on. Rather than just accept the simple answer of perimenopause, I wanted to dig a little deeper since I know as a Functional Medicine Nutritionist that perimenopause is a recalibration time for women, and our weaker systems which already were calling for support can speak even louder. I worked within conventional medicine to order a full CMP (comprehensive metabolic panel - standard for an annual exam), a full lipid/cholesterol panel, full blood sugar panel, and inflammation markers in conventional blood labs and I ran a DUTCH hormone test and GI MAP Functional Stool Test. And then I worked on what showed up on the labs: low functioning thyroid, unstable blood sugars, overworked stress system (HPA Axis), and poor digestion and absorption as well as gut dysbiosis. It was a slow and steady process but slowly but surely I had more energy, better sleep, strong digestion and my hair grew back thick! (THAT was really the kicker to know it was working!)

Today, I am officially in menopause and I am more or less symptom free and feel and look better than I did in my late 30s.

If you feel anything like I did a few years ago and want to dig deeper than just your numbers of estrogen and progesterone, read on..

Is it perimenopause… or is it your thyroid?
Thyroid dysfunction can affect energy, mood, sleep, temperature regulation, weight, hair, skin and menstrual cycles—symptoms that can look remarkably similar to hormonal changes. A full thyroid panel is TSH, T4 and T3 and ideally thyroid antibodies. I work with MANY women who thought they had been tested for hypothyroidism for years when really they only had TSH checked. This is merely measuring what the brain is telling the thyroid to make, not what the thyroid is actually making (T4) and how it is actively being used (T3). Estimates suggest that up to 60 percent of women suffering from Hypothyroidism are never detected nor treated. Like me!

Is it perimenopause… or is your blood sugar regulation struggling?
Large swings in blood glucose and insulin can contribute to energy crashes, cravings, irritability, poor concentration and disrupted sleep. And chronic metabolic stress can add another layer to an already changing hormonal landscape. A full blood sugar panel is fasting glucose, fasting insulin and hemoglobin A1C. Standard is fasting glucose which only gives data from the last 24 hours. Stable blood sugar is necessary for life. And it is KEY for stable sex hormones in fertile years and smooth perimenopause and menopause in later years.

Is it perimenopause… or is your HPA axis / stress-response system under too much pressure?
Long-term stress, insufficient recovery and poor sleep can affect the systems that communicate with the brain, adrenals and reproductive hormones. Sometimes the question isn’t simply, “Which hormone is low?” but “What is asking the body to work harder than it should?” While we may often ‘know’ on some level that our burning the candle on both ends is asking a lot of our stress system, we often don’t get how much and what all it is affecting in the body. Progesterone and cortisol share a common precursor molecule (pregnenolone). Under chronic stress, the body prioritizes making cortisol over reproductive hormones, depleting available progesterone. So your progesterone levels can be in menopausal ranges even well before menopause. Cortisol can also dampen overall sex hormones estrogen as well and your lower your overall stress tolerance, driving cortisol higher. Your adrenals (which make cortisol) are also responsible in menopause for making your available estrogen. If they are depleted, they have a hard time doing that job.

And then there are the less obvious pieces: Are you getting enough protein and amino acids? Enough magnesium and other essential minerals? Are you eating enough overall? Are you digesting and absorbing what you’re eating? Are nutrient deficiencies, inflammation, medications, alcohol, caffeine, or chronic sleep disruption contributing to the picture?

The important point isn’t to decide that everything is “just stress” or “just nutrition” instead of perimenopause. It’s that there can be more than one thing happening at the same time.

Perimenopause is a real biological transition—but it happens in a whole body.

So instead of asking only:“Is this perimenopause?”Perhaps the better question is:“What systems are contributing to how I feel right now?”That question opens up a much bigger—and more useful—conversation.

I work with a lot women to help navigate perimenopause, and the years before, with ease. Reach out to learn more about how to blend both conventional and functional medicine with nutrition and lifestyle. This could be a time you feel your best. Not your worst.