Is It Hormones… Or Something Else?
If you’re in your late 30s, 40s, or early 50s and suddenly don’t feel like yourself, hormones are an obvious place to look.
Maybe you’re more tired than you used to be. You’re waking up in the middle of the night. Your brain feels foggy. Your mood has changed. Your clothes fit differently even though you haven’t dramatically changed your routines.
And, of course, your periods may be doing something completely new.
Could it be perimenopause?
Absolutely.
But one of the most important things I tell my patients is this:
Not every symptom that happens during perimenopause is necessarily caused by perimenopause.
Perimenopause can cause very real symptoms
Perimenopause is the transition leading up to menopause, when ovarian hormone production becomes increasingly variable. It can last 10+ years for some.
For some women, the first clue is a change in their menstrual cycle. For others, symptoms show up well before they realize their hormones are changing.
Common symptoms can include:
Changes in menstrual cycles
Hot flashes and night sweats
Difficulty sleeping
Brain fog or difficulty concentrating
Mood changes
Headaches or migraines
Vaginal dryness or discomfort
Changes in sexual function
Changes in body composition
These symptoms are real, and women deserve to have them taken seriously.
But they also deserve a thoughtful evaluation.
Because “it’s your hormones” isn’t always the whole answer
Many symptoms associated with perimenopause overlap with other health issues.
Take fatigue, for example.
Poor sleep from night sweats can certainly leave you exhausted. But fatigue can also be associated with iron deficiency, thyroid dysfunction, inadequate nutrition, certain medications, sleep disorders, and much more…
The same is true of brain fog. Hormonal changes during the menopause transition can affect cognition, but sleep, stress, thyroid function, nutrient deficiencies, medications, and other factors can contribute as well.
And then there’s weight.
Changes in body composition are common in midlife, but I’m cautious about explanations that reduce everything to one hormone. Metabolic health, sleep, nutrition, physical activity, medications, aging, and hormonal changes may all be part of the picture.
Sometimes hormones are a major piece of the puzzle.
Sometimes something else deserves our attention.
Very often, it’s more than one thing.
Do you need hormone testing to diagnose perimenopause?
This is another common source of confusion.
Hormone levels can fluctuate considerably during perimenopause, which means a single hormone test may not give us a definitive answer.
For many women over 42 with typical symptoms and changes in their menstrual cycles, perimenopause can often be identified clinically based on symptoms and history rather than relying on one hormone measurement.
That doesn’t mean laboratory testing is never useful.
Depending on your symptoms and medical history, testing may help us investigate other potential contributors to the way you’re feeling. In some situations, hormone testing may also be appropriate when the diagnosis is less clear.
The important distinction is that testing should answer a clinical question—not simply generate a long list of numbers.
And what about hormone replacement therapy?
bHRT can be an excellent treatment option for many women, particularly for symptoms such as hot flashes and night sweats. It may also provide additional benefits for appropriately selected patients.
But I don’t think the starting question should simply be:
“Do I need hormones?”
A better question is:
“What is contributing to the way I feel, and which treatments are most appropriate for me?”
For one woman, hormone therapy may be an important part of the answer.
For another, we may discover that sleep, thyroid function, iron status, metabolic health, nutrition, or another issue also needs attention.
And for many women, the best plan involves addressing several things at the same time.
Looking at the whole picture
When I evaluate a patient who thinks she may be experiencing perimenopause, I want to understand more than her estrogen level.
I want to know what has changed.
What are her periods doing? How is she sleeping? What does her medical history look like? What medications and supplements is she taking? What has already been tested? What has she already tried? Which symptoms are affecting her quality of life the most?
That bigger picture helps us decide what deserves further investigation and what treatment options make sense.
Because women in midlife deserve better than either extreme:
“Everything is hormones.”
or
“Your labs are normal, so nothing is wrong.”
There’s a lot of room in between those two statements—and that’s often where we find the most useful answers.
Not sure where to start?
My Comprehensive Strategy Session is designed for women who want to take a deeper look at what may be driving their symptoms and develop an individualized plan.
The session includes an in-depth medical evaluation, review of your history and symptoms, and appropriate laboratory testing.
Learn more about the Comprehensive Strategy Session → Here
This article is for educational purposes only and is not intended to diagnose or treat any medical condition. Individual recommendations, including whether hormone therapy or laboratory testing is appropriate, depend on your personal medical history and should be discussed with a qualified healthcare professional.
