Your Symptoms Are Real Even When Bloodwork Is Normal-Navigating Perimenopause

Your blood work says “normal,” but you’re lying awake at 3 a.m., feeling off in your own skin, and wondering why your mood has a shadow you can’t explain. That disconnect is one of the most confusing parts of perimenopause, especially when symptoms are subtle at first and then suddenly feel louder after you finally bring them up in a medical visit.

We walk through what’s really happening in the perimenopausal transition and why common hormone labs like FSH, LH, estrogen, and progesterone can miss the story when hormones fluctuate day to day. I also share a functional medicine lens that favors patterns over single data points, plus why patience is not the same thing as doing nothing. When sleep, hot flashes, cycle changes, joint pain, and mood shifts are in motion, your best clarity often comes from tracking across weeks and months instead of chasing one “perfect” test.

Then we get practical: how to use a 90-day perimenopause tracker to journal symptoms, stress load, and lifestyle factors in a simple way that builds real insight. You’ll hear how this kind of tracking can support decisions about prevention, insomnia support, and even whether it might be time to talk with a menopause specialist about hormone therapy or other options. If you’re a partner listening, we also share why this can be a thoughtful gift that supports the women you love.

Get a Free Copy of the 90-Day Perimenopause Tracker For a Limited Time:

90-Day Perimenopause Tracker

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Transcript

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Welcome & Introduction

SPEAKER_00 0:53

Welcome back to the Art of Healing podcast. Or welcome if this is your first time. If we had met before, if you've worked with me one-on-one, joined one of my webinars, listened to the podcast previously, or you were a part of the summit we did earlier this year. Welcome back. Good to see you again. If this is our first time to meet, I'm Dr. Charlize. I'm a physician and a Reiki master, and I practice functional medicine and I offer Reiki. And I am so happy that you are here. So to start this episode, I would like to ask you how you would handle this situation as a patient. So let's just pretend that maybe you are a woman that's in her middle ages, maybe late 40s, maybe early 50s, maybe even your late 30s.

The Perimenopause Patient Scenario

SPEAKER_00 1:48

And let's say that you're starting to notice subtle changes, nothing that jumps off the page for you. So maybe you're noticing that, you know, over the last few months have been more nights that you don't sleep well, but you don't know what wakes you up. Or maybe you're noticing just a general sense of feeling unwell, not quite anxiety, but just feeling a little doom and gloom. It doesn't persist every day. Like maybe you get distract yourself and you forget, or you go out with friends and you forget. But then when you're not distracted, you notice that feeling. Or maybe you're noticing sometimes not feeling comfortable in your clothes, feeling warmer than usual, or feeling warm and cold, or so you know just subtle symptoms. So you have heard maybe you sit in on the summit, or you've learned from a book or from friends and family that you probably were to get some blood work done because you're probably about to go through the change. And let's say you do see your doctor, you get your labs drawn, you get the panel that would typically be ordered in primary care, and the answer you get back on your patient portal is your labs are normal, everything's good. See you in a year, everything looks good.

When Labs Come Back Normal

SPEAKER_00 3:02

Let's say you've gotten those lab results, and maybe a little bit of time has passed, you know, a couple weeks till your doctor got the results to you. So what are you gonna do now? What happens now? Especially because as a patient, maybe you notice that since you talked about these symptoms, they're worse. You maybe you're noticing you actually feel worse than when you went in to see the doctor. So what's what should you do now? This is a place that many of my patients have been in definitely myself. I mean, I will, you know, full disclosure because I am a physician, I can order my own labs and I've you know been to other doctors and had labs ordered. So I definitely know that feeling that you're for sure something's gonna be wrong. You're sure that maybe your thyroid's failing, like your aunt. You have an aunt that takes thyroid medicine, so maybe it'll be like her. Or maybe you'll find out, you know, you're like you're anemic. You may have heard like your grandmother was anemic, so maybe it's that, or maybe you're really afraid something's you know really serious. So you're grateful nothing's wrong, but you still don't know what it is.

Understanding Perimenopause & Hormones

SPEAKER_00 4:09

When we are dealing with the gradual changes that can come in the perimenopausal stages of life, we are dealing with a period of life that's quite confusing. And as I have embraced and studied this more in my patients and myself, the day-to-day reality of what you could feel in perimenopause is very real. It's it's very real. So, what that could mean is the official medical diagnosis, which it's even that's kind of evolved, is it's a period of time for women that some hormonal changes are starting to happen. This may be changes in estrogen, this may be changes in what's called FSH, this may be changes in LH. There may also be changes in progesterone, testosterone. Some women might even get more advanced hormonal testing and find out that through uh salivary and urinary testing, that even their cortisol and cortisone is starting to change, and that melatonin production may not be enough to assure restful sleep. The first thing every woman needs to do that is having questions in the stages, of course, you do want to get medical help because things do need to be checked out. But for those of us that are living in that age group, you do have to brace yourself that it's very likely that you'll get back normal results. And what's even confusing is the numbers like the FSH and the LH may come back normal. So you may have noticed that you started to skip periods. So maybe you noticed you went two or three months without a period, or you may notice the opposite, where you're having two periods a month or having a period and then having some abnormal vaginal bleeding that went on for a few days, then it stopped. Everything I just described is part of the perimenopausal journey. You're not in menopause until you've had at least one year without a period. So in the perimenopausal journey, the thing that we have to start to embrace is uncertainty. And what that means is that it is completely possible, maybe even expected, that the labs like FSH and LH that you may have read should be elevated if you are moving towards menopause, may have been normal the day that you had it checked. The same thing for those estrogen levels. You may have read that those might be dropping as you head towards perimenopause and the menopause, but it may be that the day you had them checked, they may come back normal, or the estrogen levels might even look elevated. Progesterone levels might not be helpful because our body's physiology for the most of the time is going to keep those lower. We know that perimenopause women will likely have lower progesterone levels, but the number by the time that you get it and trying to figure out what do you do, because now you're noticing that you really aren't sleeping most nights. That's it's much worse than what you told your doctor. That lab might not give you anything exactly to act

The Power of Tracking & Patience

SPEAKER_00 7:50

on. My journey from traditional medicine where it's just, hey, come in, you got a problem, get appeal into the functional, more holistic medicine has taught me something very important that I use for myself and really helps with my patients. Or I should say two things. One is being patient when we can. Of course, when it's a medical emergency, we can't be, we gotta act. But when we're noticing these subtle changes that are fluctuating day to day, although we're gonna want an answer for like, why did I not sleep Sunday night? And then the next week, that's you know, Saturday night, I went to bed and slept 12 hours because I was so exhausted. While we'd love to have a fast answer for that, if we can be patient and start to think not just day by day, but possibly week by week, and if we can create a system and a healing pathway for ourselves that lets us consider month by month, even that we can start to build our own story and we can actually start to help ourselves if we're on that parimenopausal journey to understand where we might be. But it does take some patience. But if it's done in a way that's holistic, that journey can be healing, can absolutely be something that's therapeutic for you. In my own practice, I was fortunate enough to find a system that allows patients to track and to journal. And when I first started to practice this type of medicine, I didn't understand how powerful it was. And the people that have the bandwidth to do it, that when you start taking notice, and it really it's like a mindfulness approach of certain aspects of your health and your life, that it can really start to give you information. And for my patients that had been willing to track their diet, their mood, their pain levels, their energy levels, it turns out that we would learn just valuable information about things that maybe helped them feel better and things that possibly made them feel worse and led to them even seeing me as a patient. So I have started applying that same type of approach to my female patients who have started into the paramenopausal journey. What this means is that we start tracking information that could relate to hormonal changes. And when we start the journey, we understand that there's going to be some big symptoms that we kind of know to look for, sleep, hot flashes, mood changes, periods if they still show up, joint pain. And then there might be more subtle pieces of information that relate to your life, particularly for women who are in that perimenopausal stage, tend to have more complicated lives than younger women. So these are women that just statistically, not always, but statistically likely have older children who are starting some of their own transitions or big changes, you know, moving into college. They may also be caring for parents that are requiring more assistance and care. Sometimes you hear like the sandwich generation. And possibly it's the same group of women that tend to carry a bigger workload or stress burden in their jobs or their careers, probably by chance, probably because you know you're at that point where life experience kind of adds up to work experience. So you may be carrying more projects, more burdens, just whatever. But probably for women at that stage, they will just have more going on. So, in order to make some kind of attempt to wrap her minds around a perimenopausal woman who wants to maybe start addressing this because maybe she's sensing that the mood and the sleep are getting worse, and she doesn't want to see what happens. And I can't blame her. She doesn't want to see what happens when this fully manifests itself. Because we know that insomnia, unchecked, untreated, can lead to permanent changes in the brain, can make us more prone to chronic pain, can make us more prone to major depression. So she wants to be proactive. Or a woman who has a family history of osteoporosis, and she would like to know at what point she needs to think about preventing this. She might know some of the lifestyle changes, but is it time to think about more? Or for the woman that is reading about hormone therapy and thinks it may be time to start hormone therapy. That's a really powerful place to be.

Introducing the 90-Day Perimenopausal Tracker

SPEAKER_00 12:55

So I would like to introduce my latest offering, which I'm so excited. It is the 90-day perimenopausal tracker. And the purpose of this tracker is to help women who are at this stage get acquainted with themselves, get acquainted with their bodies, get a sense of how much they may be suffering, and to have something that they can take in their hands if it's time to work with a menopause specialist or their gynecologist or their primary care doctor, especially if they do believe it's time to ask for help, or they want to at least create a record so that they can know what stage they may be that they're living through, not just by the numbers, not just by the labs, but knowing what stage they're in, especially if the time may be coming to intervene. Or for women that are thinking, I don't think I'm gonna do hormone therapy, and that's completely reasonable, but I do think still understanding where you are on in your perimenopausal journey can be very empowering.

How to Get Started

SPEAKER_00 14:08

So the perimenopausal tracker will be available on Kindle. So I'm so excited. So you probably have your Kindle account on Amazon, so you'll be able to get your copy, download it, and use it as a guide. Because it's on Kindle, what I'd recommend is treat yourself to a fancy. I'm gonna create the fantasy for you because this is my own fantasy, but maybe you and some girlfriends decide you're gonna go ahead and start this together. So this would be a perfect girls' women's day brunch. Maybe go to your favorite coffee shopslash bookshop, grab a treat, and then shop for the prettiest journal and the prettiest ink pen that you can find, especially if you're a bibliophile. That's an excellent treat. So I would say get your parametapusal tracker, especially now because there's gonna be a promotion as we launch this book. You and your friends head out, head to your fancy bookshop or wherever to pick out the journal that you want to keep in your hands and carry with you in a beautiful pen. And what you're gonna do is create this tracker, and the journal is gonna walk you through how to set it up, simple recordings that you'll make, and then a few exercises that you can do along the way to help support your journey. This is a whole 90-day series of tracking information, but I am a firm believer that once you get the first few weeks under your belt, you're going to want this time because that tracking is not just going to be you tracking. This is getting reacquainted with yourself, it's some quiet time, some mindfulness for yourself. And I believe you can use this as a firm decision point of you collecting information and figuring out how you want to address the next six months or year of your health. And the good thing with this tracker is you can revisit it. So if you do the tracker, you make some decisions, work with your healthcare team, you can always revisit it and check how you're doing, depending on where you are in the paramenopausal journey. Because one thing you don't hear a lot of people saying is that the paramenopausal period's not short, it can be up to 10 years. So you do want to have something that you can prep that you know you can return to to track how you're doing, because it is possible that the way you feel now may be different from how you feel a year from now, likely different from how you'll feel five years from now. And so that's different from when we're in our reproductive phases when we could somewhat predict what was going to come every month. So in your show notes, you will see a link to get started with the Perryman and the puzzle tracker. You want to get it now because we are launching with a promotion. This will be the best time to get it at the cheapest price. And then treat yourself and your friends to that bookshop, coffee shop, journal shopping, and get started with that and just see what you find out for that first week, for that first month. And at each point, the tracker is going to guide you through the big assessments you want to make at that time. Then, when you're done with this tracker, this is information you can take to your physician. If you're seeing me, bring it to me. Speaking of, for those working with me, there will be a version of this coming through my practice where we will do this together over 90 days. I'll tell you more about that over the coming weeks. But yes, make sure you check your show notes, get your copy, have a look, share with your friends, your family, make it something that's a ritual for yourself. Even better if you can make it a ritual for a group. I am gonna start my own tracker here in a few days. I'm gonna treat myself to a nice, I love journals, so I'm gonna treat myself to a new journal and start to track myself as well, just to figure out where I'm at. So yeah, if you will check your show notes, you can get started. I'm so excited for you. So thank you so much for listening to today's episode.

Closing Thoughts & Gift Suggestion

SPEAKER_00 18:31

Show notes for details how to stay in touch, how to get a copy of that tracker. Otherwise, I will see you soon. And it is so wonderful to connect. I do want to close with saying if you are male and you're listening, this might be a good gift purchase for the women in your life, for your wives, sisters, daughters, aunts. It's not a terrible thing to get them to share with them. I know that men don't quite think about like this way, but honestly, my crew, you all are some of the most empathetic, sweetest, angelic-like creatures I've ever met are the part of podcast in the community. So as I'm closing, I just occurred to me that I, you know, for the men that are listening, and I know that you're there, that you're listening because you have deep love and empathy for the women in your life. So this is a good way to show her you care, to share this with her and acknowledge that maybe you don't want to know all the details and you can't get into it, you're not comfortable with it, but you want her to have five or 10 minutes with herself, to be with herself and to comfort her during this transition. So think about it as a gift. I think it'd be a lovely gift. All right, listeners. I'll see you guys soon. Send me a message in the app that you are listening. Please rate and review because it always helps us. Thanks so much.