When symptoms of perimenopause show up, it’s easy to jump to the most obvious explanation—especially when you’re told it “fits your age. Our Head of Patient Experience, Brittany Turner, experienced this firsthand. Brit, as her friends call her, did exactly what many women would do, assume that at 41 she was heading into perimenopause and passively accept her fate. Because she works with Dr. Blum though, it didn't take long for her to start questioning solutions, what she and Dr. Blum uncovered really highlights how our team approaches all things holistic health and hormones.
A few months ago, Brit began noticing changes in her energy, stress response, and menstrual cycle. At 41, she assumed what many women are told to assume: this must be perimenopause. What she uncovered instead was that her iron has dipped dramatically and in-turn had wreaked some havoc internally.
Here’s her story:
Some background: Before I started semaglutide, back when I started TAC with Dr. Blum at the end of 2022, my A1C was “normal,” but trending upward—and my insulin was secretly high, overstimulating my ovaries and throwing my hormones off. Once I started my weight loss journey, my insulin load dropped and everything began to stabilize: my androgens calmed down, my cycles became more predictable, my cravings and cortisol mellowed out, and my whole rhythm felt more “normal” again. About two years into my journey, after the metabolic reset had already done its job, I noticed some fatigue, a few changes in my menstrual cycles, and an increase in what triggers stress for me. At 41, my immediate thought was, "This is it—perimenopause." It turns our that it wasn’t and what was actually happening was much easier to miss.
The Missing Piece: Iron Deficiency
Before starting my GLP-1, I was likely hovering right above a state of iron deficiency -- even though my hemoglobin appeared normal. Elevated insulin can mask iron deficiency by artificially supporting red blood cell survival, which means standard labs don’t always tell the full story. At the time, I was experiencing fatigue and irregular menstrual cycles. Looking back, those symptoms were likely being driven by anemia-related thyroid strain and subtle hormonal disruption, including slightly elevated total testosterone. Those things continued even after my elevated insulin stabalized lower and hemoglobin started to reflect where it actually was.
Why did this happen?
Elevated insulin can temporarily stabilize energy levels, ovulation, thyroid function, and blood sugar, which can mask both the symptoms and lab patterns of iron deficiency. Once my insulin levels lowered, that metabolic “noise” cleared, and the iron deficiency became much more apparent because my hemoglobin reflected it. Chronically high insulin disrupts metabolic function by suppressing fat breakdown and forcing the body to rely primarily on glucose for energy rather than stored fat. This is why insulin resistance often shows up alongside elevated triglycerides. Over time, elevated insulin also activates inflammatory pathways, increasing markers like CRP and cortisol, raising oxidative stress, and reducing mitochondrial efficiency.
Why This Wasn’t Caught Before
This would have never been caught by my PCP. When I shared my concerns about possible perimenopausal symptoms, they were considered consistent with my age. She mentioned iron supplementation, outside of the context of these symptoms with the guidance that my iron was low and I should start to supplement it. She didn't mention that it could be the cause and these symptom and my hormones weren’t tested. We had never established a baseline of where my hormones were so I really would never know if I were moving into perimenopause, outside of just age range. I also mentioned it to my OBGYN, who agreed it sounded typical for this stage of life.
Who caught it that these issues were iron related and not hormonal shifts driven by perimenopause? Our team at TAC. During my annual maintenance blood work, we added hormone testing to establish a baseline, and that’s where the real answer surfaced. I’m not in perimenopause and my iron was low. The iron was causing both the symptoms and other biometric strains adding to those symtoms.
Once my iron deficiency was addressed, my labs normalized. Elevated testosterone and thyroid strain resolved, and the symptoms I had been experiencing like energy changes, stress, and mood shifts, soon disappeared. I’ve apparently got years before I need to worry about supplementing my hormones, but when it’s time, I’ll know my baseline normal and I’m armed with knowledge (vs. “sounds about right for your age”)
Curious What Might Be Under the Surface?
If you have questions about how we help patients look deeper into their health, our team is here. Reach out to info@theaestheticconcierge.co to learn more about comprehensive blood work and a more thoughtful approach to care.
