Persistent tiredness around forty or fifty often has more than one possible cause. The three most common are menopause, long-term stress and anaemia. They cause partly the same complaints, but three blood values help to tell them apart: TSH, ferritin and cortisol.
I notice that many women in this phase attribute their tiredness to menopause in advance. Sometimes that is right, but just as often something else is involved, or several things at once.
Below you place the three causes side by side.
Why do these causes look so alike?
Menopause, chronic stress and anaemia share many complaints: tiredness, poor sleep, irritability and concentration problems. That makes it hard to decide by feel what the source is. On top of that, it often occurs together, which makes the picture even more complicated.
Precisely because the complaints overlap, a symptom alone gives little direction. A few targeted blood values usually bring more clarity.
How do you recognise menopause?
Menopause often announces itself with complaints linked to a fluctuating hormone balance. Besides tiredness, you mainly see cycle changes and hot flushes. The age, usually between 45 and 55, fits the picture.
Signs that often fit menopause:
- A period that becomes more irregular or changes
- Hot flushes or night sweats
- Sleeping worse, sometimes apart from the flushes
- Mood swings and irritability
If you want to dig deeper here, read our article on perimenopause, its symptoms and solutions. That helps you recognise the phase you are in.
How do you recognise long-term stress?
With long-term stress your body stays in a heightened state of alertness for a long time. That drains you, even if on paper you sleep enough. The tiredness often feels different: more a feeling of being burnt out than of weakness.
Signs that often fit chronic stress:
- A feeling of being burnt out or overstimulated
- Trouble relaxing or falling asleep
- Worrying and a short fuse
- Physical complaints such as headache or a tense neck
The line between menopausal complaints and stress or burnout is not always sharp. Our article menopause or burnout: how to tell the difference helps you keep those two apart.
How do you recognise anaemia?
Anaemia mainly causes tiredness through a shortage of oxygen transport. In women in this age group a heavy period often plays a role, precisely in the years before menopause. The complaints resemble those of menopause, but have a different cause.
Signs that often fit anaemia:
- Tiredness that does not go away with rest
- Paleness, breathlessness or palpitations
- A heavy or long period
- Dizziness or cold hands and feet
If you want to walk through these signs calmly, read our article on recognising anaemia symptoms in women. It also covers which values bring anaemia into view.
Which blood values help tell them apart?
No single value points out the cause on its own, but three values together give direction. TSH says something about your thyroid, ferritin about your iron stores and cortisol about your stress system. The table below links each value to what it shows.
| Value | Mainly relates to | What it shows |
|---|---|---|
| TSH | Thyroid (overlaps with menopause) | Detects a slow thyroid as a cause of tiredness |
| Ferritin | Anaemia and iron deficiency | A low reserve can already cause tiredness |
| Cortisol | Stress and the adrenal hormone | Gives context with long-term stress complaints |
The thyroid deserves separate attention here, because a slow thyroid causes complaints that strongly resemble menopause. You can read more about that in our article on a slow thyroid and menopause.
Want to test specifically? The Iron status brings your iron stores into view, and the Thyroid Complete looks more broadly at your thyroid. Which fits depends on your complaints and what you want to rule out.
When should you have your values checked?
A busy period is allowed to make you tired. It gets more interesting if the tiredness lasts for weeks or if you cannot place the cause. Then a few values can help to see where your attention should go.
Consider a check if you recognise this:
- You have been tired for weeks and cannot pinpoint the cause
- You doubt whether it is menopause, stress or something in your blood
- You have a heavy period alongside your tiredness
- Your complaints fit several causes at once
A result points you in a direction, but is not a diagnosis on its own. So always discuss your values with your GP, who places them in your context.
Frequently asked questions
Can I have both menopause and anaemia?
Yes, that occurs together regularly. A heavy period in the years before menopause can deplete your iron stores, while the hormones are already fluctuating. That is why it is useful to look at both causes separately.
Which test should I do first?
That depends on your complaints. With a heavy period, iron is an obvious choice, with hot flushes and cycle changes, menopause and thyroid. Your GP or the assessment with your result helps you choose what is useful.
Does a cortisol measurement help with stress?
Cortisol can give context, but one measurement does not prove burnout. The value fluctuates over the day and is influenced by many factors. That is why you always look at it in connection with your story and your other values.
References
- Santoro N. Perimenopause: From Research to Practice. J Womens Health (Larchmt). 2016;25(4):332-339.
- Taylor PN, Albrecht D, Scholz A, et al. Global epidemiology of hyperthyroidism and hypothyroidism. Nat Rev Endocrinol. 2018;14(5):301-316. PMID: 29569621.
- Verdon F, Burnand B, Stubi CL, et al. Iron supplementation for unexplained fatigue in non-anaemic women: double blind randomised placebo controlled trial. BMJ. 2003;326(7399):1124.
- Thuisarts.nl. I am tired. Dutch College of General Practitioners. Available via thuisarts.nl.
Every blood test result through Lunara includes a professional assessment by a BIG-registered doctor. For treatment decisions, discuss your results with your GP.
Autor
