In Detail
Perimenopause is diagnosed primarily on clinical grounds — age, menstrual pattern, and symptom history. A woman in her forties with shortening cycles, new sleep disruption, and worsening premenstrual symptoms is almost certainly in perimenopause, even if her labs look 'normal' on a given day.
Hormone levels fluctuate dramatically during this phase, so a single FSH or estradiol value can be misleading. We use lab work strategically: a thyroid panel, ferritin, complete blood count, comprehensive metabolic panel, and sex hormones timed appropriately. The labs help rule out mimics and guide treatment — they do not, by themselves, confirm or exclude perimenopause.
If your cycles have changed, your sleep has changed, or you simply do not feel like yourself, a consultation is a reasonable next step.