Are Your Perimenopause or Menopause Symptoms Linked to Hypothyroidism?

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If you are a woman with a thyroid condition that is being treated by your doctor, you may still be continuing to struggle with a variety of symptoms.

One of the first questions you need to consider is if the symptoms you are experiencing—and attributing to your thyroid—may actually be related to perimenopause or menopause.

Menopause can be a loaded word for some women, and you may be inclined to think "there's no way, because I'm still having menstrual periods," or "I'm only in my early forties." But it's important to understand that menopause is defined as the point at which you haven't had a menstrual period for a year. The average age of menopause in American women is 51 years old.

Perimenopause, however, is defined as the period leading up to menopause. The shifts in your hormones can take place as long as ten years before you are officially "menopausal." This means that if you're a woman in your late thirties to early forties, you may be in early perimenopause; although, most women begin perimenopause in their forties.

Biology of Perimenopause

What triggers perimenopause is that as you get older, your baseline levels of estrogen and progesterone begin to decline. At the same time, your supply of follicles drops, and the follicles that remain are less sensitive to stimulation. In addition, the eggs that remain are older.

The natural drop in estrogen that occurs during perimenopause often causes symptoms, such as hot flashes and night sweats. As your hormone levels further drop and menopause approaches, your levels of circulating follicle stimulating hormone (FSH) rise dramatically, in an effort to stimulate the remaining follicles to ovulate. At the same time, your ovaries cut back on production of estrogen.

Eventually, your stock of viable eggs is depleted, and your hormone levels cannot trigger ovulation, menstruation stops, and menopause occurs.

Signs and Symptoms of Perimenopause

Signs and symptoms of perimenopause include:

Menstrual Irregularities

Menstrual changes that may occur during perimenopause include heavier menstrual flow, bleeding at shorter intervals than three weeks, continual spotting or flow every two weeks, clotting with cramping, light spotting after sex, and phantom periods (you have all the signs and symptoms of a menstrual period, without bleeding).

It's important to note that while some bleeding irregularities can be expected during perimenopause, any significant irregular bleeding should be evaluated to rule out pregnancy, fibroids, or cancer, and all postmenopausal bleeding must be evaluated promptly by a physician.

Breast Changes

Swollen and tender (sometimes lumpy) breasts may occur during perimenopause, as well as shrinking, sagging, and reduced firmness in breasts.

That said, if you notice any change in your breast tissue, be sure to get it checked out by your doctor, even if you recently had a normal screening mammogram. 

Vaginal Issues

Due to the decline in estrogen levels in your body, you may notice dryness and an irritated feeling in the vagina. This may make sex more uncomfortable. 

Urinary Issues

Starting in perimenopause, you may notice more frequent urination, a tendency toward urinary tract infections, and stress incontinence.

Sleep Problems

Sleep difficulties that may arise during perimenopause include difficulty falling asleep, frequent waking, waking frequently to urinate, inability to go back to sleep after waking, waking early

Weight Gain

Weight gain is common in perimenopause. Many women also notice a redistribution of weight from the lower body to the abdomen, waist, hips, and thighs, as well as a decrease in muscle mass.

Mood Changes

Women report a number of mood problems in perimenopause like irritability, rapid mood swings, inability to cope with stress, extreme emotionality, anxiety, and depression.

Hair Loss and/or Growth

Thinning or loss of hair from the head or body may occur, as well as a receding male-pattern style hair loss at the temples. Some women develop unwanted hair on the chin, upper lip, and abdomen. 

Skin Changes

Thinner, drier skin, more prominent wrinkles, and even adult-onset acne or a condition called formication (an itchy, tingly sensation under the skin) are seen in perimenopause. 

Other common perimenopausal symptoms include:

  • Hot flashes
  • Night sweats
  • Lower bone density
  • Elevated cholesterol levels
  • Fatigue or lack of energy
  • Heart-related problems: including rapid heartbeat, heart palpitations, and an irregular heartbeat
  • Concentration and memory problems
  • Muscle and joint aches and pain
  • Low sex drive 

Is it Your Thyroid or Perimenopause?

As you can see, there are many symptoms—fatigue, weight changes, and hair loss, for example,—that are common to both thyroid irregularities and perimenopause.

How can you tell what is triggering your symptoms?

First, you need to make sure that your thyroid treatment is optimized. That means that your TSH and free T4 are at appropriate levels that safely offer maximum relief from symptoms. 

Second, it's helpful to keep track of your menstrual cycle, characteristics, and symptoms for several months, to show your physician. Keep a calendar or chart that tracks your menstrual periods, including PMS symptoms, the heaviness of your menstrual flow, and other characteristics (like clots and color.)

If you have significant signs of perimenopause, or symptoms that are not relieved by optimal thyroid treatment, and you're over 40, it's time to want to work with your physician to evaluate your hormonal status.

A review of your schedule, symptoms, an FSH test, evaluation of sex hormones (for example, estrogen and progesterone), a pelvic examination, and a thorough family and personal medical history, may help your doctor determine if you are experiencing perimenopause.

Finally, if there are significant imbalances in your sex hormones that are causing symptoms, your doctor may suggest medications (for example, hormone replacement therapy) or lifestyle changes to help restore balance and relieve symptoms.

A Word from Verywell 

The rate of hypothyroidism goes up significantly during perimenopause and after menopause; however, it's important to understand that your thyroid is not directly related to the symptoms of menopause (most of those are due to a complex combination of both estrogen loss and increased age).

Overall, the take-home message is that if you are struggling with fatigue, weight gain, depression, or other symptoms of hormonal balance, make sure you request a thorough thyroid screening from your healthcare provider.

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Article Sources
  • del Ghianda S, Tonacchera M, Vitti P. Thyroid and menopause. Climacteric. 2014 Jun;17(3):225-34.
  • The North American Menopause Society. (2014). The Menopause Practice: A Clinician’s Guide, 5th ed. Mayfield Heights, OH: The North American Menopause Society.