5 CLUES YOUR DOCTOR MIGHT BE MISSING WHEN YOU SAY “I’M TIRED”

It’s 3 p.m. and your third (or is it the fourth?!) coffee isn’t even touching the sides. You drag yourself out of bed each morning, move through the day like you’re wading through mud, and feel like you can never get enough sleep! You’ve been to the GP, rattled off every symptom - bone-deep fatigue, brain fog, zero patience - only to be told everything is "fine," and it’s normal for a busy Mum over 40. But you *know* something’s not right.

Here’s the problem as I see it: doctors simply don’t have enough time to properly explore your symptoms. And too often, feeling tired is dismissed as ‘standard’ for women, especially women over 40, in perimenopause or menopause. There’s also the additional issue that even when they do agree to testing, standard blood test ranges are set up to spot disease, not the subtle changes that affect your energy, mood, and metabolism years before any full-blown disease or dysfunction develops.

In this blog, I’m digging into five critical clues about what’s behind your fatigue, that even well-meaning doctors frequently miss when you say, “I’m tired.” We’ll talk through hidden thyroid struggles, silent iron depletion, why your sleep’s tanked (and the progesterone drop behind it), blood sugar spikes and crashes, and stress hormones out of rhythm, plus the exact questions to bring to your next appointment.

CLUE #1 – YOUR THYROID’S “NORMAL”

Thyroid-stimulating hormone (TSH) can sit at the top of the lab’s reference range while free T3 idles at the bottom, leaving you tired, puffy, and wondering if your head’s full of cotton wool. On paper you’re “within range,” but functionally you can be sliding into sub-clinical hypothyroidism.

Research shows sub-clinical hypothyroidism affects up to 8% of adults and climbs with age. I see so many women blaming a lack of discipline or willpower, or feeling like they’re doing everything wrong, for how they’re feeling; when they’re actually experiencing the negative impact of sub-clinical hypothyroidism on their energy, mood, and metabolism.

WHY IT’S MISSED

Most labs still use a wide TSH range (0.4–4.0 mIU/L), which is designed around diagnosing an overt dysfunction or disease that may then be supported with medication. Applying functional or optimal ranges (1–2) allows us to pick up trouble well before it becomes an overt dysfunction and medication becomes the only option. This also acknowledges the impact that thyroid hormone imbalance can have on you.

ASK YOUR DOCTOR

• “Can we check free T3 and free T4 alongside TSH?”

COMPARE

• “Where does my TSH sit compared with the optimal 1-2 window?”

CLUE #2 – FERRITIN IS LESS THAN OPTIMAL

Ferritin is a protein that your body uses to store iron. Because more is not always more when it comes to iron in our blood stream. Our body heavily gate keeps iron uptake (absorption) and availability. So ferritin tells us how much iron you’ve got in the bank. It’s a better marker to check than serum iron or haemoglobin, when it comes to your body’s stores/levels.

The standard range suggests everything is fine above 30 µg/L, however, studies link levels around 30 µg/L to hair loss and that bone-deep fatigue. I see you struggling when your levels are below 75, let alone 30. Of course I also see lots of you with single-digit ferritin still smashing through your To-Do list, with the help of cortisol and adrenaline. I honestly don’t know how you get out of bed!

Optimal for ferritin is around 100, but honestly you’ll feel like a different person if you can get your ferritin to at least 50, if not 75. If you want to know more about iron and how to increase ferritin without giving yourself constipation, check out this blog: https://www.theperimenopausenaturopath.com.au/blog/Iron-Deficiency-In-Perimenopause

Heavy and/or shorter cycles (closer-together periods) in perimenopause drain ferritin/iron stores faster. (Remember in early perimenopause, it’s all about more! More periods, more blood loss, more food intolerances, allergies, more rage/anger, more estrogen…) Of course you also need to be eating iron-rich foods, (and have capacity to break them down, absorb the iron, and utilise it), but for many women over 40, you may feel that you don’t tolerate some of these foods well anymore, because of a change in your digestive function.

SPOT THE SIGNS

Persistent tiredness, breathlessness on mild exertion (going up the stairs), circles under your eyes, low motivation/mojo, brittle nails, or that receding ponytail.

ASK YOUR DOCTOR

• “Can we do a full Iron Studies panel and see my ferritin, not just serum iron or haemoglobin?”
• “Can we re-test in a few months time to make sure supplementing is working?”
• Don’t accept “you’re just someone who needs to supplement all the time.” If you’re not experiencing heavy periods, you eat iron-rich foods, and your iron stores are low, ask “Why might my stores be low?”

CLUE #3 – SLEEP IS A DISTANT MEMORY

You’re bone-tired, but still scrolling at 11 pm, then up before six for a workout before work. Sound harsh? Research shows nearly half of mid-life women clock < 6 hours a night. The natural decline in progesterone, our built-in chill pill, in our late 30s and early 40s can be a big part of why sleep becomes the first domino to fall. Your stress resilience tends to be the next one to go, followed by your mood!

Not enough sleep basically makes us all giant toddlers.

Short sleep messes with your energy production, food choices, insulin levels, and encourages fat to camp out round your waist. If you’d like to know more about what less than 6 hours/night sleep does to your weight, then check out this blog: https://www.theperimenopausenaturopath.com.au/blog/sleep-and-weight-loss

WHY IT'S MISSED

GPs have few non-sedative tools for sleep, so the conversation usually starts and ends with “put your phone away, try to get to bed earlier.” Sometimes they may tell you to go to the chemist and get some magnesium or melatonin (if you’re over 50 in Australia, you can buy it without a prescription!)

ASK YOURSELF

• “What practical steps can I take to build a solid 7–8-hour sleep window?”
  Reduce blue-light exposure, supplement with magnesium and glycine at bedtime, protein at every meal, and some slow carbs throughout the day… There are lots of things you can try. Here’s some of my faves: https://www.theperimenopausenaturopath.com.au/blog/sleep-better-in-peri-menopause 

CLUE #4 – BLOOD-SUGAR + INSULIN YO-YO

While your fasting glucose may look “fine,” your insulin levels may be climbing or chronically high — fuelling belly fat storage, afternoon energy slumps, and restless nights. It’s very difficult to lose weight with a fasting insulin above 8 (even if you’re doing “all the right things”).

A two-hour post-meal glucose, fasting insulin test, or a fortnight with a continuous glucose monitor often catches what a simple fasting glucose misses. Continuous glucose monitoring units are more accessible to non-diabetics these days, and give you a wealth of information about how your body responds to different foods.

ASK YOUR DOCTOR

• “Can we check my fasting insulin?”
• “Can we do a post-meal glucose test?”

CLUE #5 – CORTISOL & DHEA OUT OF SYNC

Stress hormones should rise in the morning and taper off in the evening, to help you get out of bed, go about your day, and sleep well at night. Chronic stress, whether it’s emotional, mental, or physical from under-eating, over-exercising, or too little sleep, flip that curve, leaving you wired at bedtime and wiped out at breakfast time. As I mentioned in the last blog, DHEA is our natural anti-aging hormone, that gives us pep in our step. Age depletes DHEA, but high cortisol really lowers levels significantly. Low DHEA can also contribute to low libido and low mood.

ASK YOUR DOCTOR

• “Could we run a diurnal cortisol test?” This is a blood test with two draws - one at 8am, one around 4/5pm. Ideally you’d test cortisol at multiple points across the day, but you may need to refer yourself for that. Send me a message on Instagram if you’d like to know how to do that.
• “What’s my DHEA-S compared with age-optimal ranges?”

BRINGING IT ALL TOGETHER

Feeling like yourself again often starts with testing and analysing smarter, not necessarily more. The five clues above rarely travel alone; address them and the domino effect on energy, mood, weight, memory and concentration can be huge.

READY FOR NEXT STEPS?

Book a free Clarity Call and we’ll map out a plan for you to get the tests, personalised nutrition, and lifestyle changes to match your body’s unique needs in perimenopause. In the meantime, share this post with a friend who keeps saying, “I’m just so tired.” They deserve answers, too.