Tired for 2 years in a way that sleeping did not touch. Hair coming out more than it used to. Bloods done twice, normal twice. By the time she stopped mentioning it, she had half decided she was making it up.

What nobody had joined up

Her iron stores had been sitting near the bottom of the range for years. Every single result had been reported as normal, because every single one was. Nobody had put the 3 of them side by side and noticed which direction they were going.

Periods still arriving more or less on time, so nobody had said the word perimenopause to her. Falling asleep fine and waking at 3am. Anxiety that felt genuinely new, and always worst in the week before her period.

What nobody had joined up

Six separate complaints, each with a perfectly reasonable explanation of its own. Stress, work, age, not enough sleep. Taken together, in a woman in her early 40s, they were not six problems. They were one pattern.

The same food and the same walking, and suddenly a different result. Weight settling round the middle rather than anywhere else, and a 4pm crash she had started planning her afternoons around. She had been told her sugars were fine.

What nobody had joined up

They were fine, and they had been fine for years, which is exactly what you would expect at that stage. Fasting glucose measures the result. Nobody had looked at how hard her body was working to keep it there.