She usually starts with some version of this:
“I just don’t feel like myself.”
She’s exhausted. Her sleep has changed. She’s gained weight around her middle even though she hasn’t really changed how she eats.
Maybe her patience is shorter. Her brain feels slower. She’s rereading the same email three times or walking into a room and forgetting why she’s there.
So she does what she’s supposed to do.
She makes an appointment.
Her provider orders bloodwork.
And a few days later, she gets the message:
“Everything looks normal.”
Okay.
Then why don’t I feel normal?
That’s usually where I want to start.
“Normal” is information. It’s not the whole answer.
First, let me be clear: normal lab results can be reassuring.
If your kidney function is normal, I’m happy about that. If your blood counts look good, great. I’m not looking for something to be wrong just because you don’t feel well.
But a lab value sitting inside a reference range doesn’t automatically explain how you feel.
Think about your body temperature.
Let’s say your normal temperature is around 97.6. Today it’s 99.0.
Technically, you don’t have a fever.
But if you’re achy, shivering, exhausted and telling me you feel terrible, I’m probably not going to say:
“Well, you’re under 100.4, so everything is fine.”
I’m going to keep asking questions.
Labs should work the same way.
The number matters. But so does the person attached to the number.
Sometimes the bigger question is: What did we actually test?
I hear this all the time:
“My thyroid was checked. It was normal.”
So I ask:
“What did they check?”
And usually I get a completely reasonable answer:
“I don’t know. Thyroid?”
Fair enough.
Most people do not spend their free time memorizing thyroid markers.
But sometimes “we checked your thyroid” means one marker was checked. Depending on your symptoms, history and medications, I may want more information.
The same thing can happen with iron.
Maybe you’ve developed heavy periods. You’re exhausted, your hair is shedding and lately you get winded walking upstairs.
You were told your iron was fine.
Okay. What was actually checked?
A CBC? Ferritin? Iron studies?
Or maybe you’ve been told your blood sugar looks great.
Wonderful.
But if you’ve also noticed increasing belly fat, energy crashes after meals, intense cravings and other metabolic changes, I may want to know what your insulin is doing to keep that glucose looking so good.
That’s why I don’t just want to know:
“Were your labs normal?”
I want to know:
What was actually tested, and did those tests answer the question we were trying to answer?
Those are two very different things.
Hormones add another layer
This gets especially interesting in perimenopause.
A lot of women expect hormone testing to work like a pregnancy test.
Run the test. Get the answer.
Perimenopause doesn’t always cooperate like that.
Your hormones are fluctuating during this transition.
Estrogen doesn’t simply start high and slowly travel downward in a nice, predictable line.
It can be high. Then low. Then high again.
Ovulation can become less predictable. Progesterone production can change. Your cycle may shorten, lengthen or occasionally disappear, only to show up again when you thought you were finally done buying tampons.
So one hormone level is a snapshot.
And sometimes a snapshot is useful.
But I also want the movie.
When did your sleep change?
When did your periods change?
Did the anxiety show up around the same time?
When did you start gaining weight differently?
Did your libido change?
Are the symptoms worse at certain points in your cycle?
For many women in their 40s, the pattern of symptoms and menstrual changes can tell us more about the menopausal transition than one random hormone level.
That doesn’t mean I don’t use labs. I do.
I just want a lab to help answer a question, not replace the conversation.
Same symptom. Completely different story.
Here’s a good example.
Two women come into my office.
Both are 46.
Both tell me:
“I’m exhausted.”
Woman #1 is suddenly waking up at 2 or 3 in the morning. Her periods have become unpredictable. She’s developed anxiety that feels completely unlike her, and every once in a while she wakes up sweaty.
Woman #2 sleeps eight hours straight.
Her periods are still regular, but they’ve become incredibly heavy. Her hair is shedding. And lately she’s noticed she gets winded more easily.
Same age.
Same complaint.
But I’m already asking these two women very different questions.
With the first, I’m thinking about hormonal changes and what’s happening with her sleep.
With the second, I’m very interested in her blood count and iron status, among other things.
Neither woman needs me to simply look at the word fatigue and pick a treatment.
I need the story around it.
Because “I’m exhausted” isn’t a diagnosis.
It’s the beginning of the investigation.
And sometimes it isn’t hormones at all
This may sound strange coming from someone who treats hormones all day, but it’s important:
Not everything that happens to a woman in her 40s or 50s is hormonal.
Could hormones contribute to fatigue, poor sleep, brain fog, mood changes, body composition changes and low libido?
Absolutely.
But those symptoms can also show up with thyroid dysfunction, iron deficiency, insulin resistance, sleep apnea, medication effects, chronic stress and plenty of other things.
Sometimes there’s more than one thing happening.
That’s why I’m not a fan of either extreme.
One is:
“Your labs are normal. You’re fine.”
The other is:
“You’re 47. It’s your hormones.”
I don’t want to guess from either direction.
I want to figure out what actually makes sense for you.
This is where we connect the dots
This is probably my favorite part of what I do.
Imagine dumping a puzzle onto a table.
Your symptoms are pieces.
Your labs are pieces.
Your menstrual history is a piece.
Your medications are pieces.
Your sleep is a piece.
Your stress, nutrition and metabolic health are pieces.
Your medical and family history are pieces.
If I pick up one piece and stare at it long enough, I can tell you quite a bit about that one piece.
But I still don't know what the picture is.
My job isn't to stare really hard at one puzzle piece.
It's to figure out how the pieces fit together.
And sometimes labs confirm exactly what I suspected.
Sometimes they send us in a completely different direction.
Sometimes they help rule something out.
Sometimes they tell me we need to ask another question.
That's what they're supposed to do.
I’m not ordering labs hoping to find something wrong.
I’m using them to help us understand what’s going on.
So what happens when everything is “normal” but you still don't feel normal?
We don't automatically decide your labs are wrong.
And we don't automatically decide your symptoms are hormonal.
We ask better questions.
What changed?
When did it change?
What symptoms are showing up together?
What was actually tested?
Does timing matter?
Is there something else that could explain what you're experiencing?
And then we put your labs next to your symptoms, your timeline and your history.
Not above them.
Next to them.
Because your lab results, your symptoms and your story should all be part of the same conversation.
That’s really the philosophy behind how I practice at Midlifesy.
I don’t want to treat a lab report.
I don't want to treat “fatigue.”
And I don't want to assume every woman who walks through my door needs hormones.
I want to understand why you don't feel like yourself anymore.
Then we can figure out what deserves our attention and what we’re going to do about it.
Because sometimes “everything looks normal” is reassuring.
But when you still don't feel normal?
It shouldn't always be the end of the conversation.
Sometimes it's where the better conversation begins.
When You’re Ready to Connect the Dots
If you’ve been told everything looks normal but you’re still dealing with fatigue, brain fog, changing sleep, weight changes, mood shifts, low libido or that hard-to-explain feeling that something is just off, the SHIFT Clarity Consult™ was created for exactly this kind of conversation.
We look at your symptoms, your history and your data together. Then we turn that information into direction and a clear plan for what comes next.
Because you don't need another stack of lab results.
You need to understand what they mean for you.
[Schedule Your SHIFT Clarity Consult™]--