Is It Perimenopause or Something Else? Understanding the Real Reasons You Might Not Feel Like Yourself

You know something’s changed, but you’re not sure what.

Your cycle’s different. Your sleep’s off. You feel more anxious, more tired, more bloated and maybe even a little more unlike yourself than you want to admit. You’re told it’s “just getting older” or “probably perimenopause.” But what if it’s more than that or something else entirely?

While perimenopause is real and valid (and starts earlier than most women expect), it’s not always the whole story. The symptoms you’re experiencing might overlap with thyroid dysfunction, blood sugar instability, chronic stress, or even nutrient deficiencies.

Understanding what’s actually going on is the first step toward feeling better, without guessing or being dismissed.

What Is Perimenopause, Really?

Perimenopause is the transition phase leading up to menopause, when the ovaries begin to slow estrogen and progesterone production. This shift can begin as early as your mid-30s to early 40s, long before your period actually stops.

Common signs of perimenopause include:

• Irregular periods
  
• Shorter or longer cycles
  
• Heavier or lighter bleeding
  
• Night sweats or hot flashes
  
• Mood changes
  
• Brain fog
  
• Sleep disruption
  
• Weight gain or bloating
  
• Low libido
  

It’s a natural transition, but that doesn’t mean it’s easy and it doesn’t mean you should accept every symptom as “just how it is now.”

When It Might Be Something Else

Here’s where things get tricky: Many of the most common perimenopausal symptoms overlap with other imbalances, especially in women 35 – 50. This can make it hard to know what’s really going on.

Here are a few conditions that mimic or exacerbate perimenopause symptoms:

1. Thyroid Dysfunction

Low thyroid (hypothyroidism) can cause fatigue, mood swings, constipation, low libido, weight gain, irregular periods, and hair thinning. Sound familiar?

TSH may look “normal” on a lab report, but many women feel symptomatic long before the labs catch up.

2. Cortisol Imbalance (Chronic Stress)

High or dysregulated cortisol from ongoing stress can disrupt sleep, worsen PMS, throw off your cycle, and deplete progesterone, amplifying perimenopausal symptoms.

3. Blood Sugar Instability

Feeling irritable, fatigued, anxious, or craving sugar constantly? Blood sugar swings (even without diabetes) can mimic hormone imbalance and make hot flashes, night waking, and mood swings worse.

4. Nutrient Deficiencies

Magnesium, B vitamins, zinc, and omega-3s all support hormone production and nervous system regulation. When depleted (common with stress or birth control history), you may feel more anxious, inflamed, or hormonally “off.”

5. Gut Imbalances

Your gut plays a key role in metabolizing and clearing hormones. If you’re bloated, constipated, or reacting to more foods lately, your gut may be affecting your hormonal symptoms more than you realize.

How to Know What’s Really Going On

If you’re in your late 30s or 40s and suddenly feel like your body is changing, it probably is. But it doesn’t mean you’re powerless and it doesn’t always mean hormones are the only thing out of sync.

What matters most is context:

• When did symptoms start?
  
• How are they showing up in your cycle, sleep, energy, and mood?
  
• What other systems might be involved?
  

This is where working with a practitioner who listens, investigates, and looks at the big picture can change everything.

“Perimenopause doesn’t cause every symptom, but it can magnify underlying imbalances that were already there.”
— Dr. Jolene Brighten, ND

You Don’t Have to Guess Your Way Through This

Hormone transitions are normal. But they don’t have to be chaotic, confusing, or dismissed as “just how it is now.” At Wholesome Health, we help you untangle the overlapping pieces, so you can understand what’s driving your symptoms and what your body actually needs to rebalance.

If you’re feeling foggy, inflamed, anxious, or disconnected from your cycle, it’s time to stop guessing.

Book your free 30-minute discovery call here.

You don’t have to do this alone. 

To learn more about how we can help ease hormonal changes, check out our hormone services page.

References:

1. Brighten, J. (2019). Beyond the Pill. HarperOne.
   
2. Gottfried, S. (2013). The Hormone Cure. Scribner.
   
3. Office on Women’s Health, U.S. Department of Health and Human Services. Perimenopause.
   https://www.womenshealth.gov/menstrual-cycle/perimenopause
   
4. Mayo Clinic. Menopause and perimenopause: What to expect.
   https://www.mayoclinic.org/diseases-conditions/perimenopause/symptoms-causes/syc-20354666