Think It’s Perimenopause? Here’s Why It Might Not Be

Perimenopause... Are You Sure?

I love that menopause and perimenopause are finally getting the attention they deserve. Women in their 40s and 50s no longer have to suffer in silence, told it is “just part of life” and dismissed. The conversation is becoming mainstream, empowering many to seek help and demand better care.

But I wonder - could this new awareness also be to our detriment?

I ask this because I see an emerging trend where any symptom in midlife is labelled “perimenopause” without question. Are we sure that is what is going on? Could we be missing something else?

When Hormone Landscapes Change, Illness Can Appear

Puberty, pregnancy, and perimenopause are three life phases where the hormonal landscape changes dramatically. These shifts can unmask or trigger illness. For example, autoimmune conditions often appear or flare during these hormonal shifts. Pregnancy is known to trigger or worsen autoimmune thyroid disease, and puberty is a common time for the first signs of type 1 diabetes or other autoimmune issues to emerge.

Perimenopause is no different. It is a time when the immune system, metabolism, and hormones are all recalibrating. Illnesses can surface for the first time, yet often we chalk it up to “just hormones”.

What Else Could Perimenopause Symptoms Be?

If you are experiencing fatigue, brain fog, mood changes, weight gain, hair loss, or digestive symptoms, it is worth considering other possible causes alongside perimenopause.

Some of these include:

• Blood sugar dysregulation or insulin resistance: Research shows that nearly 1 in 10 women aged 45-54 in the UK has type 2 diabetes. Many more have prediabetes or insulin resistance without knowing it. Blood sugar highs and lows can mirror perimenopausal symptoms: anxiety, irritability, fatigue, night sweats, brain fog, and low mood.

• Thyroid dysfunction: Hypothyroidism becomes more common in midlife women, with 1 in 8 developing an underactive thyroid at some point. Autoimmune thyroiditis (Hashimoto’s) is the leading cause, often missed for years as its symptoms overlap with perimenopause: fatigue, weight gain, constipation, depression, dry skin, and hair thinning.

• Other autoimmune conditions: Conditions such as rheumatoid arthritis, lupus, coeliac disease, and autoimmune gastritis can all surface or worsen in midlife, presenting with vague or overlapping symptoms such as joint pain, fatigue, digestive upset, or anaemia.

• Nutrient deficiencies: Midlife women are at risk of low iron (especially with heavy periods), low B12, folate, vitamin D, and magnesium. These deficiencies can cause symptoms like low mood, anxiety, fatigue, palpitations, tingling, headaches, and brain fog. It is important not to assume these are hormone-related without checking levels.

• Adult ADHD becoming unmasked: Emerging evidence shows that perimenopause can reveal underlying ADHD in women who have masked symptoms for years. Changes in oestrogen affect dopamine and executive function. While ADHD does not suddenly appear in adulthood, midlife hormonal changes can make symptoms unmanageable for the first time, leading to diagnosis. A 2022 review in Current Psychiatry Reports highlighted that perimenopause is a key time when women with undiagnosed ADHD present to clinicians as their coping mechanisms falter.

  
  

Could It Still Be Perimenopause… and Something Else?

Of course, it can be perimenopause. Hot flushes, irregular periods, night sweats, sleep disruption, mood changes, vaginal dryness, and memory lapses are common due to fluctuating oestrogen and progesterone. But what if those symptoms are being made worse by something else?

What if your fatigue is due to iron deficiency anaemia, your anxiety is fuelled by blood sugar swings, or your hair loss is from an underactive thyroid? What if your “brain fog” is partly perimenopause but partly early insulin resistance affecting brain glucose delivery?

I ask these questions with every client. Because while hormone changes are real and impactful, they do not happen in a vacuum. Midlife is a time to check under the bonnet.

Looking Beyond the Label

I am delighted menopause is being discussed openly and compassionately. But I also believe we must keep asking questions.

If your symptoms feel severe, sudden, worsening, or out of proportion to what you hear from others, seek medical checks. Ask for thyroid function tests (including antibodies), blood glucose and HbA1c, fasting glucose, full blood count, iron studies, liver function, vitamin B12, folate, and vitamin D levels at minimum. These (and many more) are tested in my Wellness Check If needed, seek further investigation for autoimmune conditions - which I can also run privately if needs be.

Perimenopause is a journey. Make sure you are not walking it while another condition is quietly draining your vitality in the background.

The earlier we act, the more we can shift.

Book a free 20-minute ‘Health Review’ call today, and let’s discuss your health in detail.

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