I sat in my car for a good ten minutes before I could make myself drive away.
I’d just walked out of my own doctor’s office. Not as a nurse, but as a patient. I’d gone in wanting to talk about hormones and asked for lab work because I wanted more information about what was happening in my body before making any decisions about hormone therapy.
My doctor looked at me and said, “Oh, we don’t do that.”
I asked why.
She explained that treatment was based primarily on symptoms, and I didn’t appear to have enough symptoms to warrant much concern. Which was interesting, considering I hadn’t actually told her what I’d been experiencing yet.
I explained that I wasn’t asking her to prescribe anything. I wasn’t asking her to fix me. I wanted information. I wanted a fuller picture of what was happening in my body so I could make an informed decision about what, if anything, I wanted to do next.
“We don’t do that either.”
She knew I was a nurse. She knew women’s hormone and metabolic health was my work. And I still had to push harder than I should have needed to before she finally agreed to order the labs. Even then, she reminded me that the results weren’t likely to change what she would prescribe.
I walked out, got into my car, shut the door, and sat there.
Because suddenly this wasn’t only about me.
If I, a nurse who knew what questions to ask and was comfortable pushing back when the conversation shut down, had to work that hard to get a fuller discussion, what happens to the woman who doesn’t know what to ask? What happens to the woman who isn’t sure whether her symptoms “count”? What happens when she’s told everything looks fine and assumes that means she should feel fine too?
That question is a big part of why Symptoms Leave Clues exists.
The Part I Almost Missed
My own experience with perimenopause started before I became deeply educated in women’s hormone and metabolic health. I was in nursing school during much of that transition, learning medicine while also trying to understand what was happening in my own body.
And I almost missed it.
Part of the reason was simple. I didn’t know enough yet.
When the Usual Clues Don’t Apply
I had a hysterectomy in my early thirties, so I hadn’t had a menstrual cycle in years. And think about how perimenopause is usually described. Your periods become irregular. Your cycle gets shorter. Then longer. You skip a month. Your bleeding changes.
For millions of women, those changes are useful clues.
I didn’t have them.
There was no irregular period announcing, “Hey lady, estrogen and progesterone are starting to get a little weird over here.”
Instead, my clues were quieter. I didn’t have the energy to get through the day quite like I used to. Sleep looked decent on paper, but I wasn’t waking up feeling restored and ready for my day. My already thin patience completely disappeared. The mental sharpness I had always relied was starting to feel a step behind.
Nothing dramatic happened. There wasn’t one symptom I could point to and say, “There. That’s the problem.”
So I did what women do every day. I explained each one away.
I’m busy. I’m in nursing school. I didn’t sleep enough. Work has been stressful. I’m getting older. Maybe this is simply what happens now. I am just getting older.
At the time, I didn’t yet have the depth of knowledge I have now. I didn’t know how many systems could be affected by changing hormones. I didn’t understand how easily perimenopause could show up as a collection of small, seemingly unrelated changes rather than one obvious symptom.
And at the same time, I was beginning to see another problem from the inside.
I was learning how healthcare works while also experiencing how easily women’s symptoms get minimized, separated into little boxes, or brushed aside when they don’t fit a clean textbook picture.
That combination changed the direction of my work.
My own lack of answers made me want to understand more. Watching women get dismissed made me want to understand why. The deeper I went into hormones, metabolism, sleep, insulin resistance, body composition, stress physiology, and longevity, the more obvious it became that women were being asked to solve interconnected problems one symptom at a time.
The Quiet Clues Count Too
That is one of the most important things I wish more women understood about perimenopause. It doesn’t always arrive with hot flashes and wildly irregular periods. Sometimes the first sign is simply that your body stops responding the way it used to.
Your sleep changes. Your recovery changes. Your mood feels less predictable. Your brain feels slower. Your body composition starts shifting even though you haven’t suddenly forgotten how to eat. Stress hits differently. Alcohol hits differently. The routine that worked beautifully five years ago suddenly stops working the same way.
And because each change seems small on its own, women spend years treating them like separate problems. A sleep problem. A weight problem. An anxiety problem. A motivation problem. A “maybe I’m getting old” problem.
Meanwhile, the hormonal environment underneath all of those systems is changing.
Perimenopause is not simply estrogen steadily dropping until menopause arrives. Hormones fluctuate throughout the transition. Progesterone often begins changing as ovulation becomes less consistent. Estrogen rises, falls, and shifts unpredictably. Those changes interact with systems involved in sleep, mood, body composition, glucose regulation, temperature regulation, cognition, and more.
Which means your first clue might have nothing to do with your period.
And if you don’t have periods, like me, waiting for a menstrual clue is a pretty lousy strategy.
I Wasn’t Walking In Blind This Time
Years later, after I had gone much deeper into women’s hormone and metabolic health, I found myself sitting in that doctor’s office asking for a broader look at what was happening in my body.
This time, I knew more.
I knew the questions to ask. I knew enough to understand the limitations of hormone testing. I knew a single estradiol or FSH result would never tell the whole story. I also knew I wanted more context before making decisions about hormone therapy.
And I still encountered resistance.
That was the part that stayed with me. Because by then, I had the language. I had the clinical background. I had the confidence to keep asking.
Many women don’t.
This is also why I get frustrated when women are told some version of, “Your labs are normal, so you’re fine.”
Labs are one piece of information. Symptoms are another. Your history matters. Your sleep matters. Your nutrition matters. Your stress load matters. Your muscle mass matters. Your metabolic health matters. Your medications matter. Your goals matter.
Hormone testing itself has limitations during perimenopause because levels fluctuate. One result does not neatly diagnose the entire transition. That does not make information useless. It means the information needs context.
And context is exactly what gets lost when healthcare becomes a short conversation about whether your symptoms are bad enough yet.
You shouldn’t have to wait until you’re miserable before your body becomes worth investigating.
There is also no single “right” way to move through perimenopause. For some women, menopausal hormone therapy becomes an important part of the conversation. For others, improving the foundational layer changes far more than they expected.
Eating enough protein. Getting adequate fiber. Building and protecting muscle through resistance training. Supporting blood sugar regulation. Sleeping enough. Reducing the constant physiological load of running on caffeine, adrenaline, and determination.
Plenty of women use both.
The point isn’t to convince every woman to take hormones. The point isn’t to convince every woman she should manage without them either. The point is to understand enough about your own body to participate in the decision.
That’s where I think women have been shortchanged.
We have spent years being handed isolated answers to interconnected problems. Trouble sleeping? Here’s something for sleep. Anxious? Here’s something for anxiety. Gaining weight? Eat less. Tired? You’re busy. Brain fog? Welcome to getting older. Period changing? Well, now maybe we should talk about menopause.
Except your body has been talking the entire time.
Symptoms leave clues.
The work is learning how to read them together.
That’s also what I’m doing inside the paid side of Symptoms Leave Clues. I go deeper into the labs and health markers worth understanding, what each one does and does not tell you, questions worth bringing to your clinician, and why “within the reference range” doesn’t always answer the question you were asking.
Paid subscribers also get Make It Make Sense, my private podcast, where we take topics like hormone therapy, lab testing, metabolism, symptoms, and healthcare conversations apart piece by piece.
Because sometimes you don’t need another wellness tip.
You need someone to explain what the hell all of this means.
Upgrade to paid → HERE
The Goal Is Better Information
I don’t tell this story because one frustrating doctor’s appointment deserves its own dramatic reenactment. I tell it because my experience on both sides of healthcare changed the direction of my career.
First, I was the woman who didn’t know enough to connect her own symptoms.
Then I became the nurse who learned how many women were living the same story.
Then I became the patient who walked into an appointment armed with more knowledge and still had to push to get the conversation I was asking for.
Those experiences are connected. They are why I study this work. They are why I teach it. And they are why I want women to understand their bodies before they reach the point where everything feels impossible to ignore.
You don’t need to wait for your symptoms to become loud enough, disruptive enough, or textbook enough before you start paying attention.
Pay attention to the quiet clues too.
Sometimes they are where the story starts.