You walk into a room and forget why. You park the car and, twenty minutes later, can’t picture where. You’re tired, but your mind is buzzing at 2 a.m. And you think: Is this my thyroid? Is this perimenopause? Or is it just me?

It’s one of the most common questions women bring to me, and it’s a fair one. Let’s sort it out.

Why do thyroid and perimenopause feel so much alike?

Both change how your body handles energy, temperature, mood, sleep and digestion. Thyroid hormone sets the pace for a lot of what your cells do. Estrogen and progesterone shifts during perimenopause touch many of the same things. So fatigue, brain fog, poor sleep, anxiety, changes in weight and hair changes can come from either one.

There’s a large UK study that asked this very question: is it thyroid or is it menopause? The symptoms overlap so much that it’s hard to tell by feel alone. And here’s the part I want you to hear: it can be both. It can also be neither.

So no, you’re not imagining things. Your symptoms are real. But “which label fits?” may not be the most useful question.

What if it’s both, or neither?

The question I care about is this: what is keeping you from feeling like the best version of you?

That’s a different question from “which diagnosis do I get?” A diagnosis can be a helpful starting point. But two women with the same one can have very different things driving their symptoms. That’s why I say the face of hypothyroid and Hashimoto’s is different for everyone.

Thyroid function also depends on more than one gland. There are many pathways that influence how your thyroid hormone is made, converted and used. (Dr. Datis Kharrazian, whose work shaped mine, describes more than 20 of them.) That’s why a single number rarely tells the whole story. TSH, the pituitary signal that tells your thyroid how hard to work, is one piece of the puzzle. It’s a useful piece, but still just one.

What does “test, don’t guess” actually look like?

It means picking the question first, then choosing the test that answers it. Not everyone needs everything. Here are the kinds of questions I look at, depending on your history:

Are your hormones where they should be? Beyond a standard blood panel, I use at-home saliva kits. You collect the samples in private and mail them to the lab. They can show your hormone levels and the metabolites, which are the byproducts that show how your body is breaking those hormones down. Think of it as a wider lens on the same picture.

What’s going on with your brain chemistry? The same kind of kit can look at neurotransmitters, the chemical messengers in your brain and gut. GABA helps you settle and sleep. Serotonin is tied to mood. Acetylcholine is involved in memory, which is the “why did I walk in here?” department. These results are one input. I read them alongside your symptoms and history, never alone.

How is your gut doing? Your gut and brain talk to each other through the vagus nerve, and a large share of your body’s serotonin is made in the gut. That’s one reason I look at patterns across systems rather than one marker.

Is T4 turning into T3? T4 is the storage form of thyroid hormone, and T3 is the active form your cells use. If the conversion isn’t happening well, I want to know why: the liver, the gut, inflammation, stress? Asking “if not, why not?” is the point.

And here’s how I work through it: “We don’t throw the whole kitchen sink at things all at once.” We go through one system at a time. That keeps it from feeling overwhelming, and it keeps you from ending up with a counter full of supplements.

In my own practice, I’ve seen how different two women can look. One young mom came to me with severe brain fog. Her testing showed low GABA, Hashimoto’s and leaky gut. Her answer wasn’t the same as anyone else’s, and yours won’t be either.

Where do weight, GLP-1s and peptides fit in?

If the scale hasn’t moved even though you’ve been diligent, that’s frustrating, and it isn’t a character flaw. Sometimes it has a gut-shaped answer. For example, some research links low levels of a gut bacterium called Akkermansia to a harder time losing weight. That doesn’t mean a probiotic is a weight-loss fix. It means the question “why isn’t this working?” may have more than one answer.

You’ve probably also heard about GLP-1 medications and peptides. They’re newer tools, and women ask me about them often. Here’s where I stand. Just because the scale doesn’t move doesn’t mean you need a peptide. But maybe you do, and that’s a conversation to have with your prescriber. I don’t prescribe or manage medication. Decisions about GLP-1s, peptides and thyroid medication belong with the clinician who does. What I can do is support you with nutrition and lifestyle alongside your medical care, and help you gather the right information to bring to that conversation.

One more piece, because so many women tell me they feel “tired but wired.” An overstimulated nervous system is often part of the picture. It’s not the whole explanation, but it’s worth attention. The supports I come back to are simple: mindfulness, time outdoors, your faith if that’s part of your life, and being patient with yourself. They won’t replace testing or treatment, but they do make a difference in how you feel day to day.

What can I ask my care team this week?

You don’t need a full workup to start. Try bringing one or two of these to your next appointment:

  • “My symptoms overlap with perimenopause. What could we check to tell whether thyroid, hormones or both are involved?”
  • “Has anyone looked at my T4 and T3 together, not just my TSH?”
  • “If my numbers are in range but I still feel off, what would be a reasonable next step?”

Write down your symptoms, when they started, and what changed around that time. That’s useful information for any clinician.

If you’d like help sorting out where to begin, I offer a clarity call. It’s a simple, no-pressure chat about your symptoms and whether deeper thyroid testing might make sense for you. If you have recent labs, send them ahead of time and we’ll look at them together. That’s also how we decide which tests you need and which you don’t. Book a clarity call

We’re not looking for perfection; we’re looking for progress. You’ve already done a lot. This is just about figuring out which piece deserves your attention next.

Be kind to yourself, sister.

Grounded in Science. Guided by Wisdom.

Joni