Is This Perimenopause? Symptoms to Watch, Why Labs Don’t Always Help, and What to Track

Perimenopause can feel like your body’s playing hormonal hopscotch — and no one handed you the rules.

One cycle, your estrogen might be lower than usual, leaving you dragging through the day with fatigue and brain fog. The next? It surges unexpectedly and suddenly your breasts are sore, your emotions feel unmanageable, and you’re crying at car commercials. Sound familiar?

That’s the nature of perimenopause – it’s like “puberty in reverse.” Hormones fluctuate unpredictably, and that can cause an incredibly wide range of symptoms.

And here’s the kicker: no two women experience this transition exactly the same way.

Your best friend might be waking up drenched in night sweats and fanning through hot flashes, while you’re navigating intense mood swings, migraines, or heavier, more frequent periods. Both of you might be perimenopausal — just with totally different expressions of it. Because the symptoms can vary so much (and can mimic other conditions like thyroid changes, iron deficiency, or depression), it’s often hard to know what’s really going on. That makes it even harder to advocate for yourself at the doctor’s office — especially when you’re met with “That’s just aging” or “Your labs are normal.”

But your experience is real. And understanding it is the first step to getting the support you deserve.

This is a great time to start tracking your cycles in more detail. Note things like:

• Cycle length and period duration

• Whether your bleeding is light, heavy, or unpredictable

• Symptoms like breast tenderness, anxiety, low mood, hot flashes, fatigue, brain fog, trouble finding words, vaginal dryness, headaches, and changes in libido

  
  

Having this kind of day-to-day detail can be incredibly helpful — not just for identifying patterns, but for making informed choices when it comes to hormone therapy or other personalized treatment options.

One important note about labs: Because hormones like estrogen and FSH (follicle-stimulating hormone) fluctuate so much during perimenopause, a single blood test isn’t usually helpful for diagnosis. You might have normal labs one week and wildly different results the next. That’s why perimenopause is considered a clinical diagnosis — meaning it’s based on your history and symptoms, not just lab values.

That doesn’t mean we skip labs altogether. In many cases, it makes sense to check your thyroid, blood counts, iron levels, and other markers to rule out additional causes of your symptoms — especially fatigue, mood changes, or cycle shifts. The goal is to build a full picture of your health, not chase one hormone number. We may also check hormones too but probably more than one time.

Because this can be a confusing time, I created a simple Perimenopause Symptom Checklist — a free tool to help you get clear on what’s happening and prepare for more productive conversations with your care team.

Click here to download the checklist.

If this sounds all too familiar, you're not alone — and you don’t have to figure it out by yourself. At Sorrel Health & Wellness, we offer personalized, judgment-free care for women navigating midlife hormones, metabolism shifts, and big life transitions.

Your Next Step to Feeling Better

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Frequently Asked Questions About Perimenopause

How do I know if I'm in perimenopause?

 Perimenopause is diagnosed based on your symptoms, not just labs. If you are noticing changes in your cycle, sleep, mood, energy, or body, it’s worth tracking those changes and speaking with a provider familiar with midlife hormone shifts.

Can I be in perimenopause if my period is still regular?

Yes. Many women begin experiencing hormonal changes and related symptoms even while their cycles are still coming monthly. Symptoms like irritability, fatigue, disrupted sleep, hot flashes, or brain fog can start before any noticeable cycle changes.

Should I get my hormone levels checked?

Maybe but it is not necessary. Because hormone levels fluctuate so much during perimenopause, a single blood test often isn’t helpful. A normal result doesn’t rule out perimenopause. Diagnosis is based more on your symptom patterns and overall health picture. Getting levels at different times in your cycle may be useful. This is also why symptom and cycle logs can be important tools.

What should I be tracking if I think I may be in perimenopause or entering the menopause transition?

Track cycle length, bleeding patterns (light/heavy, short/long), and symptoms like fatigue, mood changes, sleep issues, hot flashes, brain fog, libido shifts, breast tenderness, and vaginal dryness. These patterns help guide your care and treatment options.

What other conditions can mimic perimenopause symptoms?

Thyroid issues, low iron, depression, other hormone disorders, and even life stress can overlap with perimenopause. That’s why your provider may recommend lab work to rule out other causes — while still honoring that perimenopause might be part of the picture.

When should I talk to a doctor about perimenopause?

If your symptoms are disrupting your quality of life — or you’re simply unsure what’s happening — it’s a good time to talk. You don’t need to wait until things get “bad enough.” Early support can make this transition feel far more manageable.