03/09/2026
In clinic, this list rarely changes when a woman arrives certain that perimenopause explains everything: the fatigue, the thinning hair, the 3am waking. Hormones are part of it. They are rarely the whole of it.
Four markers, plus one process running alongside them, explain a lot of the overlap: ferritin, B12 and folate, vitamin D, a full thyroid panel, and blood sugar regulation.
Ferritin can sit inside the “normal” range on a lab report and still be low enough to cause fatigue and hair shedding, and heavier or more frequent bleeding through this transition often pushes it there.
B12 and folate work the same way. A result inside the reference range doesn’t rule out fatigue, brain fog or tingling in the hands or feet.
Vitamin D drops through autumn and winter regardless of hormonal stage, and low levels show up as fatigue, low mood and aching muscles that get written off as getting older.
A full thyroid panel, TSH, free T4, free T3 and antibodies, catches what TSH alone can miss, and thyroid conditions become more likely during this exact life stage.
Blood sugar regulation plays its own part too, a drop overnight can trigger a stress hormone response that wakes you at 2am or 3am, alongside cravings that feel out of character.
None of this replaces the conversation about perimenopause, or about HRT if that’s where you’re heading. It adds another layer to the picture, worth having in numbers, not assumptions.
I’m so glad you’re here
I talk about the foundations of what supports your health long term, not the latest wellness gimmicks.
