778: The Fatigue Problem No One Is Solving for Women Over 40 (And The Labs I Order First)

October 1, 2026 in Podcast, Women’s Health 0

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Episode Summary

You’re exhausted by 2 or 3 PM. Your workouts suddenly wipe you out. Your hair is shedding, your brain feels foggy, and even climbing a flight of stairs leaves you more winded than it used to.

Then you finally ask for help and hear: “Your labs are normal.”

In this solo episode, Dr. Mariza breaks down one of the most commonly missed contributors to persistent fatigue in women: iron deficiency, even before anemia develops. She explains newly released American Society of Hematology ferritin thresholds and why women who were previously told their iron was “normal” may deserve a closer look.

But iron is only one part of the conversation.

Dr. Mariza walks through the bigger clinical picture she considers when a woman says, “I don’t feel like myself anymore,” including thyroid function, mitochondrial energy production, blood sugar, sleep, nutrition, stress physiology, and HPA-axis regulation.

Most importantly, she explains why fatigue is a symptom, not a diagnosis and why neither stress, aging, nor perimenopause should automatically become the explanation for everything you’re experiencing.

Listen now to learn what may be hiding behind your exhaustion and how to have a more productive conversation with your healthcare provider.

IN THIS EPISODE

Why iron deficiency can exist before you become anemic
The new ferritin thresholds women should know about
Why a lab’s reference range and a diagnostic threshold are not always the same thing
Why heavy perimenopausal periods can increase your risk of depleted iron stores
The fatigue, brain fog, headaches, hair shedding, and exercise intolerance that can overlap with perimenopause
How iron, thyroid hormones, nutrition, blood sugar, sleep, and recovery influence mitochondrial energy production
Why “adrenal fatigue” oversimplifies what may actually be happening with the HPA axis
How under-fueling, over-training, poor sleep, circadian disruption, illness, and caffeine can add to the body’s total stress load
The questions to ask when you know something has changed but your labs keep coming back “normal”