The Biggest Myth About Perimenopause: Why Blood Tests Don't Tell the Whole Story

If you've been told that weight gain, anxiety, hot flashes, night sweats, fatigue, or irregular periods are simply a part of aging, this episode is for you.

In this deeply personal episode, Dr. Chhaya Makhija shares two powerful stories—one from her clinic and one from her own journey through perimenopause—to explain why symptoms matter just as much, if not more, than hormone lab values. 

She shares why many women are dismissed despite experiencing very real hormonal changes and how evidence-based care can help you feel like yourself again.

In this episode, you'll learn:
• Why perimenopause is diagnosed based on symptoms—not just blood tests
• Why estrogen, progesterone, FSH, and estradiol levels can appear "normal" during perimenopause
• The truth about weight gain, anxiety, hot flashes, and night sweats
• When hormone replacement therapy (HRT) may be appropriate
• Which blood tests and health screenings actually matter
• The role of insulin resistance, sleep apnea, bone health, and metabolic health during midlife
• How lifestyle changes and HRT can work together to improve long-term health
• Why you should never settle for being told to "eat less and move more"

Whether you're approaching your 40s, navigating perimenopause, already in menopause, or supporting someone who is, this episode will help you understand what is happening inside your body and empower you to advocate for your health.

Remember: Hormones are not your destiny. The right diagnosis, evidence-based guidance, and personalized care can change your health trajectory.

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Email: connect@unifiedendocrinecare.com

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Disclaimer: This podcast is for educational, informational, and entertainment purposes only. It’s not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider for personalized guidance.

If you enjoyed this episode, don’t forget to subscribe to the Hormones & Hope Podcast for more expert insights, real conversations, and science-backed strategies to help you feel your best—inside and out.

Transcript

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I have lived the version of it, but it doesn't mean that as a physician, as a endocrinologist, I have to live every version to figure out or understand the patient. The compassion comes from understanding, listening, but also the right knowledge of science and what's happening with your cormonal system, with that chaos, with that juggle, with that fluctuations during perimenopause. Don't take perimenopause or menopause as a negative phase in a women's life, in our life. It's actually a powerful phase. Because it's your body, you know it the best. And if you're making an empowered, well-informed decision by gaining the knowledge first, you never go wrong. But if nothing's budging, not your weight, not your temperature intolerance, you've fixed all your deficiencies, you've got your screening tests done, you've had your exercise, your caloric intake, all looked at. And despite that, you're gaining more body fat molasses. The heat intolerance is becoming unbearable, or there are hot flashes, or there's a sense of night sweats, or it's affecting your daily routine. Don't wait. This is very important to have a conversation as to what are my other options rather than feeling that you have to be stuck with these symptoms. Welcome to Hormones and Hope, a podcast where we bridge science and wellness to help transform your health. I'm your host, Dr. China Makija, or you can call me Dr. China, a triple board certified endocrinologist and lifestyle medicine physician and founder of Unified Endocrine and Diabetes Care. Each week we dive into the powerful intersection of clinical medicine and real-life lifestyle strategies to help you feel stronger, live longer, and show up as your most vibrant self inside and out. So let's get empowered. You cannot be dismissed, be it a man or a woman. You cannot be dismissed by your clinician by being told that your hormone level, that is either estrogen or testosterone, is supposed to go low because that's aging, and we cannot do much about it. Or it's just normal to gain weight, so deal with it. Or just eat less, move more, eat less, move more, and eat less, move more. Today I want to share a story. Actually, two stories. One is a patient I recently met, and the other one is mine. I'm Dr. Chai Mikirija, triple board, certified endocrinologist. So the patients I see in my clinic are relevant to all the endocrine conditions, ranging from perimenopause, menopause to thyroid disorders, to metabolic conditions, weight gain, diabetes, gestational diabetes, polycystic, meaning the new name, polyendocrine metabolic syndrome, osteoporosis, vitamin D deficiency, and even pituitary adrenaline gland problems. I end up diagnosing a lot of my patients with sleep apnea because that is leading them to cause the weight gain other than their perimenopause or low testosterone, their sleep apnea or undiagnosed or untreated sleep apnea is probably related to their low testosterone in them. Hence, my field is hormones, metabolic health, meaning how your engine runs, as well as bone diseases like osteopenia and osteoporosis. Now, if you're new to this podcast where I bring you real evidence-based science, along with several medical specialists who you've seen me interview and bring about a unified place, a platform to learn about your health, including physical, emotional, psychological, so that you can live the best of your best life and make well-informed decisions about your health. The first patient is a woman who I met just a week ago, but I had first seen her two years ago for a diagnosis of a thyroid disorder. I diagnosed her with transient thyroiditis, where she had this phase of hyper-excessive thyroid hormone, then a very brief phase of hypothyroidism or low thyroid levels, and then back to normal baseline. As she recovered from it, and then she was following her primary hair physician for the last two years, totally euthyroid, not requiring any medications. Now, she lives 60 miles away, and I recently met her again because she reached out. She reached out because she had knee concerns. Here is what she was living with. She's 48. She's been telling her clinician, her middle-level clinician, that I've had temperature changes again. I've started feeling hot again, and just a sense of nervousness all the time. Our menstrual cycles, they've gotten lighter, and sometimes she has had to skip a cycle without knowing what reason it was, especially in the last six months. And she's constantly worried, worried about something, uh, a sense of doom that she cannot express. Why is she worried? Now, she's constantly expressed her concern that is it her thyroid hormone, is it a relapse of her thyroiditis which is causing symptoms? Because she experienced a sense of anxiety. She experienced sweating and some temperature intolerance when she had this episode of thyroiditis. Now, in the last year, after 2026, there has been other changes too. Upon discussing and asking more details, she told me she's gained an average of 17 pounds despite not changing her later interventions, not changing her routine exercise. And it's been so hard to lose it, she says. She says, I've even tried fasting, but I may lose a pound here or two, feel a little better, but it's either regained or I'm just stagnant there. She is a Middle Eastern, so her diet is very close to a healthy Mediterranean diet, and nothing's changed there either. The other aspect that I went through was her life, her stresses. Now, this is where her pleat has been overwhelming, which is including her father getting diagnosed with a different kind of cancer, her husband getting diagnosed with a different cancer, and two new grandbabies that she has to be a part of in their upbringing, and she's welcomed them. Her whole life is filled with taking care of everyone else. Now, if you're a woman listening, I don't think that sounds surprising to you, meaning I am sure you're relating to her right now. You're sensing that how this woman is there for everyone else is experiencing some symptoms which are definitely deplicating and not letting her serve as much as she would want to. Now here's the part that brought her to me. She said to her clinician that I'm going through all these symptoms. The clinician said, Oh, it's not your thyroid. We looked at it a few months ago. Here is an estrogen patch. Try this, maybe it'll help you because your thyroid looks normal. The patient asked, Doctor, can I do some blood work? And her clinician said, We don't need any blood work, just try this estrogen patch and I'll see you back in six months. Then the patient expressed her concern for weight gain that my friend has had a weight loss of 30 pounds, and she's going to this some wellness place, and they have been giving her peptides and she's lost 30 pounds. She looks great, but she also feels great. She tells me she's got more energy than anyone else. Can you tell me what are these peptides and do you think I will benefit from these? Because I've been having this difficult resistant weight gain and I'm not able to lose. Her clinician's response was, Well, if you're interested in peptides, why don't you go to that same wellness place and get it? When I heard this as an endocrinologist, I had compassion for both the clinician as well as this patient. I was happy that this patient sought for more expertise for appropriate responses, and her questions were very right on mark because she was seeing a problem in her body, in her health, and she was seeking help from her clinician. Now, for the clinician, in terms of compassion, is that if they, meaning he or she, whoever this clinician was, did not have the right evidence-based knowledge or understanding, why didn't you refer this patient to someone? Why didn't you tell the patient that let me read into it and figure out what's going on? Why maybe you didn't discuss with the patient that peptides sold at wellness places are not FD approved for most of the time? They have to be well studied, FD approved. Or maybe this patient, this patient's friend, was receiving some form of comparative pre one and to at least discuss that we have FD-approved GLP1 receptor agonist. And does this patient, who is asking question, qualify for it or not? If you, as a patient, have right questions, which you do because you're thinking about your health or about your family members' health, and if you're not getting right answers, seek more answers. There are so many platforms, there are evidence-based resources. This is where we've built our library on YouTube, GRP1 guides, and many other guides, including thyroid, osteoporis, diabetes, so that you have a place to seek or ask for evidence-based signs and resources. Now coming back to this patient, I related to her, not just as her endocrinologist, but also as a woman. Now comes the next story. Because personally, I noticed a shift in my body composition, a slight increase in my body fat mass and body fat percentage, without changing anything in very abruptly in 2025. That was almost when I was turning 45. Now I was dealing with perimenopausin symptoms as well, premenstrual night sweats, unexplained fatigue where I was not deficient in D or iron or not bleeding excessively. I was eating my usual, making sure I had my fiber, my protein, bowel movements were fine, I was sleeping well, there were no crazy stressors in terms of how I was responding, just the usual life and work balance, and I couldn't explain it. So I sought expertise. Now, when I'm listening to my patient story, that's where I am listening from, a woman-to-woman, but as an endocrinologist, knowing the science, knowing the biological changes, knowing the physiological changes happening in this woman. I have lived the version of it, but it doesn't mean that as a physician, as an endocrinologist, I have to live every version to figure out or understand the patient. The compassion comes from understanding, listening, but also the right knowledge of science and what's happening with your hormonal system, with that chaos, with that juggle, with that fluctuations during perimenopause. Now, here's what I want you to understand. All these symptoms, that is sense of anxiety, sense of doom, weight gain, temperature intolerance, feeling hot all the time, night sweats, changes in menstrual cycles, they're completely irrelevant to a patient physician discussion. Because that is how we diagnose perimenopause. It does not have to be a lab number. Trust me, the labs will very likely look normal because this patient has menstrual cycles. And that is expected in perimenopause by labs, that is, estradiol levels may look normal. LHMFH, FSH, that is your PT3 signals, may appear normal. And I'm not asking you to distrust me because I said trust me, but trust the science. It's the actual biology of perimenopause. We have a large lab range for estradiol, for progesterone, for estrogen, and these tend to fluctuate every single day. I've had patients in perimenopause where physicians refer to me because their estradiol levels are skyrocketing in 400s and 500s. They haven't changed anything, they haven't applied anything new to their skin or taking an estrogen tablet or any contacted version. It is the biological change. During perimenopause, that is, could be after age 35, but more common around 40s, your estrogen levels can go up and down literally every day. You may have peak in troughs, and it may not be that steady as compared to your early 30s or 20s. And perimenopause is your clinical symptom, your history that is helping us to diagnose, and that is helping us to check mark that okay, you as a patient, as a woman patient, needs hormone replacement therapy, and then discuss the pros and cons, risk and benefit so that you can make an informed decision. Okay, so that was the conclusion and discussion that I had with my patient. Yes, you will get the lamp stamp, but I don't need that lab estrogen progesterone or LHFSH to diagnose your perimenopausal symptoms. But I'll get these as your baseline. I wouldn't want to know what your thyroid level is. I would want to know what your vitamin D is, your iron levels, your CVC, that is your hemoglobin. I would want to know what your metabolic PAMIL is, your liver, your hydration status, your kidney functions. I would want to know what your lipids are. I would want to know your inflammatory markers if you are having other symptoms like arthralgia, joint pains, aches. I would want to know your insulin resistance, your coma IR, that I talked to you about in other podcast episodes and on my YouTube videos. So that's how we start assessing your A1C, your glucose level. Okay, now coming back to perimenopause and menopause, your symptoms speak and help us make a diagnosis, not personally the labs in perimenopause, meaning you are in the transition heading towards menopause. Another important thing is let's reframe this conversation. Don't take perimenopause or menopause as a negative phase in a women's life, in our life. It's actually a powerful phase. At many occasions, I'll tell my patients and my friends or if any discussion that I'm having with colleagues about HRT, I tell them that almost at age 46, I feel younger and stronger than that, than what I was in my mid-20s or late 20s. Now, that's a combination of multiple things, including your foundations and lifestyle interventions, but also the health of hormone replacement therapy. Now, if you are a partner or a spouse, you should be helping the woman in your life identify this and also seek expertise. What about estrogen? When you receive a prescription for estrogen in any form, I'm talking about FD-approved versions, like this patient received. We know that we have bio-identical FDA-approved hormone replacement therapy for you for both perimenopause and menopause, the same medications that is FD-approved, estrogen is also FD-approved for treatment or prevention of osteoporosis if you have osteopenia, so your bone health. And as endocrinologists, we've been using it for the longest time. There are multiple indications your clinician should be discussing with you. And also while you're talking to you about bioidentical estrogen, if you need progesterone or not, if you have a uterus, you will need progesterone. And how are they going to help their symptoms? How are we going to adjust these prescriptions? What are you wanting to watch? Are there any other other deficiencies that we need to correct simultaneously? And what lifestyle interventions and what do I need to modify in my daily routine? My bedtime habits, my wake-up time habits. Do I need a sleep study? Do I have mild sleep apnea if not moderate to severe? All those evaluations are essential during this phase. We have a bone density scan. Do you need a body composition scan? For my patients, I highly recommend all of these as preventive measures. And we have screening criteria that if you are at a risk for fracturous osteoporosis, you can request your primary care physician, your gynecologist, or your endocrinologist for a screening bone density scan in that perimenopause, menopause phase, and not wait until age 65 to get a DEXA scan or bone density scan. Now, coming back to HRT, if you're one of those who is thinking that let me give my body a chance, I don't want to go on any prescription medications, let me optimize my lifestyle interventions for another three to six months, that's also a wonderful choice. Because it's your body, you know it the best. And if you're making an empowered, well-informed decision by gaining the knowledge first, you never go wrong. But if nothing's budging, not your weight, not your temperature intolerance, you've fixed all your deficiencies, you've got your screening tests done, you've had your exercise, your caloric intake, all looked at, and despite that, you're gaining more body fat mass, if your heat intolerance is becoming unbearable, or there are hot flashes, or this sense of night sweats, or it's affecting your daily routine, don't wait. This is very important to have a conversation as to what are my other options rather than feeling that you have to be stuck with these symptoms. I also wanted to leave you with this thought that we have had emerging studies in both perimenopause and menopause as subgroup analysis in many published studies on how if we are able to combine HRT and GLP1 receptor agonist in women who meet the indications like their BMI is in that overweight uh category, and they have other metabolic dysfunctions, or the BMI is greater than 30, and or if they have any other metabolic uh conditions like dyslipidemia or hyperlipidemia or prediabetes, insulin resistance, type 2 diabetes, fatty liver disease, or metabolic dysfunction, associated steatotic liver disease, and so on, sleep apnea, right? All of these need to be evaluated to figure out if the HRT and GLP1 receptor agnost both together in concert are going to be meaningful for you, clinically meaningful for you, and are going to help you optimize your health, not just lose weight. Okay, this is a very important conversation. And personally, for my patients, I never start all of these together. Remember, HRT is estrogen, progesterone, badging nestrogen in uh many women. Some women need testosterone, some women don't need testosterone. And then, of course, GLP1 receptor agonist is also a hormone. If you're taking terzipatite, it's two hormones, GLP1 and GIP. So you don't want to stack and stack all the hormones together. Never. Right? You wouldn't know what you're benefiting from, you wouldn't know what's causing uh some form of intolerance, and that's stacking it one by one is the best way to know what's helping me and what it is helping me with, and then add on to the other with your clinician, with your endocrinologist. Finally, lifestyle interventions, non-negotiable. There always a foundation. And I also want you to accept this lifestyle interventions might change. It might change based on your environment, it might change based on your uh work atmosphere and dependent on the environmental or the life challenges or stressors that you're going to face or you are facing. We have to adapt to these changes without using the consistency of movement, the consistency of good food choices, the consistency of good bedtime and waking habits, and not hesitating to ask first opinion, second opinion, third opinion if you're not getting right evidence-based, well-informed, filled with helpful answers for you by your clinician. Surround yourself with right educational resources, ask questions, especially in this era of so much information. Other than humans, you're also dealing with AI to get answers. And that's why there is more confusion that can happen because it still needs to be personalized, that is, for you. Now, I'm pretty sure that you all are listening to this episode or watching this uh episode on YouTube. You're already seeking answers and finding right resources. This patient I've been telling you about, I know she's going to have impressive changes. I personally had amazing changes that I shared with you with HRT and amplifying and modifying my lifestyle interventions with this transition in the perinanapause. I'm pretty sure her anxiety will likely dissipate as she starts the HRT. The temperature changes will also get better. And sometimes it takes two days, sometimes it may take a couple of weeks, sometimes it may take a month or two for you to witness the changes. So don't give up on discussing these questions, discussing your options, and whichever way of working with your clinician you choose, give it some time, but don't deal with misery, don't deal with symptoms. We do have solutions in this era. So today I'm talking to you, woman to woman, take charge of your health. If you're not finding solutions, seek them. Step up, share your concerns, knock on the doors, seek the right expertise and never give up. And I want to acknowledge many other physicians who've been advocating for women's health on multiple platforms because together we can up level our health. I'm not leaving our men's health today. Next week I'm going to share recent patient cases, cases with men with secondary hypogonadism in the mid-adult phase, with sleep apnea, with type 2 diabetes, with weight gain, and every time they were told, eat less, move more, eat less, move more for several years, while their metabolic changes, their A1C, their glucose, their cholesterol, their weight was just worsening. And just one conversation for those 60 to 90 minutes brought about a change in their health trajectory. We've built a whole library of videos, great guides, all grounded in evidence and simplified just for you. And before I leave you today, I am also releasing our M3, Dr. Makita's Metabolic Method Founding Cohort, where we are building the hormones and hope community. And I invite you to join, to be surrounded by like-minded people, by robust resources and expert guest interviews. You'll find the link to join us in our show notes wherever you're listening to this podcast or watching this podcast. Before I leave you, don't give up on your health. Seek the right expertise and remember, hormones are not your destiny. Until we meet next, empower yourself, enjoy the summer, and rooting for your bestest health. Signing off. Thanks for hanging out with me on Hormones and Hope. If you've loved this episode, do me a favor, hit subscribe, share it with someone you care about, and drop a review if you're feeling generous. Want more tools to support your hormones and health? Head over to UnifiedEndocrine Care.com. We've got free guides, resources, and more waiting for you. Until next time, stay curious, stay kind to your body, and keep your hormones happy.