Menopause Myth #2: Is It Actually Menopause or Could It Be Something Else?

A 48-year-old woman comes to see me. She’s exhausted — the kind of tired that doesn’t improve with rest. Her hair is falling out in alarming amounts. She’s gained nearly a stone despite no changes to her diet or activity levels. Brain fog makes her work increasingly difficult. Low mood settles over her like a heavy blanket.

She’s convinced it’s menopause. She’s read about it online, talked to friends, and all the symptoms match. She’s here because she wants to discuss HRT.

Except when we run blood tests, we discover something crucial: her thyroid function is severely underactive. She doesn’t just have menopause — she has hypothyroidism that’s been missed for months, possibly years.

This scenario isn’t uncommon. And it highlights a critical point that gets lost in menopause awareness: assuming every symptom in midlife is menopause can be just as harmful as dismissing menopause symptoms entirely.

The Myth

If you’re having symptoms in your 40s-50s, it’s definitely menopause.

The Reality

Many menopause symptoms overlap significantly with thyroid disorders, vitamin deficiencies, autoimmune conditions, anxiety disorders, and other health conditions. Proper assessment matters — both to rule out other treatable conditions AND to recognize menopause when it’s present.

Why This Matters Clinically

In my practice, I see two opposite problems that both represent failures in women’s healthcare:

Problem 1: Everything Gets Attributed to Menopause

Women with genuine medical conditions — thyroid disease, anemia, vitamin B12 deficiency, diabetes, autoimmune disorders — get told “it’s just menopause” without proper investigation.

Their treatable conditions go undiagnosed while they’re offered HRT that won’t address the root cause. They continue suffering, sometimes getting worse, because the actual problem was never identified.

I’ve seen women with:

  • Severe hypothyroidism dismissed as “menopause fatigue”
  • Pernicious anemia (B12 deficiency) causing profound fatigue and cognitive symptoms
  • Type 2 diabetes with symptoms attributed to “menopause weight gain”
  • Autoimmune conditions flaring during perimenopause but never investigated
  • Sleep apnea causing exhaustion misattributed to menopause

Problem 2: Nothing Gets Attributed to Menopause

On the flip side, women with clear perimenopausal symptoms get extensive investigations, are told “all your bloods are normal,” and are sent away — or prescribed antidepressants — when HRT or lifestyle support could transform their symptoms.

They’ve had every test under the sun. Everything comes back “normal.” They’re told “there’s nothing wrong with you” or “it’s just stress” or “maybe you need antidepressants.”

Meanwhile, their symptoms are textbook perimenopause: fluctuating mood, sleep disruption, brain fog, anxiety, joint pain. But because their hormone levels look “normal” on the day of the test (hormones fluctuate wildly during perimenopause), their symptoms are dismissed.

Both scenarios represent failures in care. Women deserve better.

The Overlap Is Real: Symptoms That Could Be Multiple Things

Let’s look at common symptom patterns and what they might indicate:

Fatigue, Weight Gain, Hair Loss, Low Mood, Brain Fog, Cold Intolerance

Could be:

  • Hypothyroidism (underactive thyroid)
  • Perimenopause/menopause
  • Both at the same time

Why it’s tricky: Up to 20% of perimenopausal women have concurrent thyroid dysfunction. The two conditions often occur together because both are more common in midlife women.

Anxiety, Palpitations, Tremor, Sleep Disruption, Weight Loss, Heat Intolerance

Could be:

  • Hyperthyroidism (overactive thyroid)
  • Perimenopause/menopause
  • Anxiety disorder
  • All of the above

Why it’s tricky: Oestrogen fluctuations can cause anxiety and palpitations that feel identical to thyroid issues.

Fatigue, Breathlessness, Dizziness, Pale Skin, Poor Concentration

Could be:

  • Anemia (iron deficiency or B12 deficiency)
  • Perimenopause/menopause

Why it’s tricky: Heavy perimenopausal periods can cause iron-deficiency anemia, so you might have both.

Joint Pain, Fatigue, Brain Fog, Mood Changes

Could be:

  • Autoimmune disease (rheumatoid arthritis, lupus, others)
  • Perimenopause/menopause
  • Vitamin D deficiency

Why it’s tricky: Autoimmune conditions often flare during hormonal transitions, and perimenopause is a common time for autoimmune issues to emerge or worsen.

Mood Changes, Anxiety, Sleep Problems, Fatigue, Lack of Motivation

Could be:

  • Depression or anxiety disorder
  • Perimenopause/menopause
  • Thyroid dysfunction
  • Vitamin B12 deficiency

Why it’s tricky: All of these affect neurotransmitter function and can present with identical symptoms.

The Evidence-Based Approach to Assessment

So how do we figure out what’s actually going on?

Step 1: Clinical History and Symptom Pattern

A thorough clinical history is the most important diagnostic tool. This includes:

Age and menstrual history: Are you in the typical age range for perimenopause (40s-early 50s)? What’s happening with your periods?

Symptom timeline: When did symptoms start? Did they appear suddenly or gradually? Do they fluctuate or remain constant?

Symptom pattern: Do symptoms worsen at certain times of your menstrual cycle? (This suggests hormonal influence)

Family history: Thyroid disease, autoimmune conditions, and menopause timing all have genetic components.

Medical history: Pre-existing conditions, medications, surgeries.

Lifestyle factors: Stress levels, sleep quality, diet, exercise, alcohol intake.

Step 2: Appropriate Blood Tests

The NICE Guidelines (2015) are clear: diagnosis of perimenopause in women over 45 is primarily clinical — based on symptoms and menstrual changes. Hormone blood tests (FSH, oestrogen) are not usually necessary because hormones fluctuate wildly during perimenopause, making single measurements unreliable.

However, NICE also recommends investigating other potential causes of symptoms, particularly:

Thyroid function:

  • TSH (thyroid-stimulating hormone)
  • Free T4 (thyroxine)
  • Free T3 (triiodothyronine)
  • Thyroid antibodies if autoimmune thyroid disease suspected

Full blood count:

  • Checks for anemia (low red blood cells)
  • Can identify infection or inflammation

Vitamin B12 and folate:

  • B12 deficiency causes fatigue, cognitive symptoms, mood changes, neurological symptoms
  • Common in women over 40, especially those with gut issues or on certain medications

Vitamin D:

  • Deficiency extremely common (40-70% of UK women)
  • Causes fatigue, muscle aches, bone pain, low mood
  • Important for bone health during menopause

Ferritin (iron stores):

  • Can be low even when full blood count is normal
  • Heavy perimenopausal bleeding depletes iron stores
  • Causes profound fatigue, hair loss, poor concentration

HbA1c (blood sugar):

  • Screens for diabetes and prediabetes
  • Perimenopause can affect insulin sensitivity
  • Important for cardiovascular risk assessment

In my practice, depending on symptoms, I might also check:

Inflammatory markers (CRP, ESR):

  • If autoimmune conditions suspected
  • If joint pain is significant

Lipid profile and cardiovascular risk factors:

  • Cholesterol, triglycerides
  • Blood pressure
  • Important during menopausal transition when cardiovascular risk increases

Coeliac screen:

  • If digestive symptoms, unexplained anemia, or fatigue
  • More common than people realize

Step 3: Clinical Judgment

Once test results are back, clinical judgment integrates:

  • The symptom pattern
  • The test results
  • The patient’s age and context
  • Response to any treatments tried

Important points:

“Normal” hormone levels don’t rule out perimenopause. FSH and oestrogen fluctuate dramatically during perimenopause. You can have a “normal” FSH on Monday and a “perimenopausal” FSH on Friday. If your symptoms fit and your age is appropriate, perimenopause is a clinical diagnosis.

Multiple things can be true at once. You might have hypothyroidism AND be perimenopausal. Treating the thyroid doesn’t exclude menopause, and vice versa.

Some symptoms resolve with treating the underlying condition; others don’t. If your thyroid is treated and you still have symptoms, it doesn’t mean the thyroid treatment didn’t work — it might mean you also have perimenopause that needs addressing.

Common Scenarios I See in Practice

Scenario 1: Thyroid Disease Missed

Woman, age 47, with fatigue, weight gain, hair loss, low mood, brain fog. Perimenopausal symptoms dismissed by GP. Started on HRT. Felt slightly better but still exhausted. Finally checked thyroid — TSH 15 (very high), clearly hypothyroid. Started on levothyroxine (thyroid medication). Energy improved dramatically within weeks.

Lesson: Always check thyroid function in midlife women with fatigue and metabolic symptoms.

Scenario 2: Perimenopause Dismissed

Woman, age 45, with anxiety, sleep disruption, mood swings, brain fog, joint pain. Extensive investigations: thyroid normal, bloods normal, FSH “normal” (tested once). Told “nothing wrong, here’s an antidepressant.” She declined antidepressants and came to see me. Clear perimenopausal symptom pattern. Started HRT. Transformed within 6 weeks.

Lesson: Normal blood tests don’t rule out perimenopause. Trust the clinical picture.

Scenario 3: Both at Once

Woman, age 49, with profound fatigue, cognitive symptoms, mood changes, irregular periods. Investigated: found both hypothyroidism (TSH 8) AND clear perimenopause. Started on levothyroxine and HRT. Needed both treatments to feel well.

Lesson: Multiple conditions often coexist in midlife women. Treat what’s found, but don’t stop looking if symptoms persist.

Scenario 4: Vitamin Deficiency Overlooked

Woman, age 52, post-menopausal, on HRT, still exhausted. Investigated: severe vitamin B12 deficiency (pernicious anemia). Started on B12 injections. Energy returned. HRT was helping with other symptoms, but the profound fatigue was B12 deficiency.

Lesson: Even when on appropriate treatment for one condition, persistent symptoms deserve investigation.

What Women Should Do

1. Track Your Symptoms Comprehensively

Include:

  • When symptoms started
  • How they’ve progressed
  • Whether they fluctuate or remain constant
  • Any patterns (e.g., worse at certain times of your cycle)
  • Impact on daily life (work, relationships, activities)

This information helps healthcare providers distinguish between different conditions.

2. Request Appropriate Blood Tests

Ask your GP for:

  • Thyroid function (TSH, free T4, free T3)
  • Full blood count
  • Vitamin B12 and folate
  • Vitamin D
  • Ferritin (iron stores)
  • HbA1c (blood sugar)

These are reasonable, evidence-based tests for women with midlife symptoms. You’re not being difficult — you’re advocating for appropriate care.

3. Remember That Normal Blood Tests Don’t Rule Out Perimenopause

If your blood tests come back normal but your symptoms fit the pattern of perimenopause (and you’re in the right age range), trust the clinical picture.

Hormonal blood tests (FSH, oestrogen, LH) are unreliable during perimenopause because levels fluctuate wildly. NICE Guidelines don’t recommend them for diagnosis in women over 45 with typical symptoms.

4. Consider Whether Multiple Things Could Be Happening

You might have thyroid issues AND be perimenopausal. You might have vitamin deficiencies AND hormonal changes. Treating one doesn’t exclude the other.

If you’re treated for one condition and still have symptoms, it doesn’t mean the treatment “didn’t work” — it might mean there’s another piece of the puzzle.

5. Find a Healthcare Provider Who Takes a Holistic View

You need someone who will:

  • Take your symptoms seriously
  • Investigate appropriately (not over-investigate or under-investigate)
  • Recognize perimenopause when it’s present
  • Also recognize when other conditions need treating
  • Work with you to figure out what’s happening

If your current provider dismisses your concerns or refuses appropriate investigation, seek a second opinion. You deserve thorough, evidence-based care.

The Bottom Line

Proper assessment isn’t about ruling everything in or ruling everything out. It’s about taking symptoms seriously, investigating appropriately, and recognizing that midlife women deserve thorough, nuanced care.

You deserve to know what’s actually happening in your body — not to be dismissed with “it’s just menopause” when it might not be, OR “it’s definitely not menopause” when it clearly is.

Sometimes it’s perimenopause. Sometimes it’s thyroid disease. Sometimes it’s both. Sometimes it’s vitamin deficiency, autoimmune disease, or something else entirely.

The only way to know is to investigate appropriately, interpret results in context, and work with a healthcare provider who takes your symptoms seriously.

Your symptoms are valid. Your concerns are reasonable. You deserve answers.

Need Support?

If you’re experiencing symptoms in midlife and aren’t sure what’s menopause and what’s not, I can help.

As a registered nurse with specialist training, I take a comprehensive approach: thorough clinical assessment, appropriate investigations, and support that addresses what’s actually happening in your body.

[BOOK A FREE 15-MINUTE CONSULTATION →] https://calendly.com/lkbayley2002/free-15-min-consult?month=2025-10

Let’s figure out what’s going on and create a plan that actually helps.

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