What else could be behind your perimenopause symptoms? 

Fatigue. Anxiety. Brain fog. Heavy periods. Poor sleep. More body fat, less energy. Sound familiar?

These are some of the most commonly discussed symptoms of perimenopause, and while changing hormone levels do play a role, they are far from the only potential drivers. In fact, many of these symptoms could also be signalling something entirely different – like iron deficiency, thyroid dysfunction, or insulin resistance.

When symptoms overlap so significantly, it’s easy to jump to conclusions or simply accept discomfort as part of a “new normal”. But the body doesn’t speak in absolutes. It speaks in signals. And understanding those signals is the key to lasting relief.

Below is a snapshot of the symptoms commonly attributed to perimenopause and how they overlap with iron deficiency, thyroid dysfunction and insulin resistance. When we say something is due to perimenopause we are blaming that symptom on changes in hormones. Yet, as you can see from the table below, the symptom might be caused by other factors, like iron deficiency, which if addressed, would then resolve. That’s not perimenopause – that’s not hormones causing it – if the symptom goes away when (for example) iron is addressed. That’s iron deficiency and it just so happens to, too often, be present at a stage in life when the perimenopause transition is also occurring. We want to address the driver of the symptom – the road in is the road out. 

 

 

It’s easy to see just how much these symptoms overlap. Take anxiety, for example – it appears across almost every scenario listed above. So how do you know what’s actually driving your symptoms?

The answer lies in stepping back and reframing how you interpret them. For example, if you experience anxiety, do you see it as a fixed part of who you are; a condition you “have”? Or can you begin to view it as a symptom – a signal from your body that something deeper needs attention?

This shift in thinking matters. When we see a symptom as a signal, it becomes an invitation to look beneath the surface, explore what might be driving it and take steps to restore inner balance. You might be someone who tends towards anxiety, but it’s also possible that something simple – and entirely addressable – like low iron is amplifying it.

This is where testing can be incredibly helpful. It can offer insights into your iron status, thyroid function, insulin sensitivity and hormone production and ratios – all of which can guide the next step forward. That said, even without testing, there are clues. If you’ve experienced heavy bleeding, very frequent periods or flooding (either recently or over many years) some degree of iron deficiency is more likely than not. And if you’ve spent years under-eating, dieting, or following a low- or no-meat way of eating, iron depletion is even more probable.

It’s also important to remember that multiple factors can coexist. For some women, there isn’t just one thing behind their symptoms – it’s the compounding effect of less-than-ideal metabolic health, nutrient deficiencies, hormonal issues, stress and more. This is why taking a holistic lens, one that considers your biochemistry, nutrition and emotional landscape, is so powerful.

Symptoms are not random. They are feedback. And when you understand what your body is trying to tell you, you can start to meet its needs more precisely – and experience the difference that brings. You don’t need to accept feeling “not quite right” or “dreadful” as your new normal. Whether it’s iron, thyroid, insulin or hormones – or a combination of them all – there are answers. 

And you deserve to find them.