Perimenopause, Menopause, and Hypothyroidism

Overlapping Symptoms and Treatment Considerations

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Thyroid disease can affect men and women of all ages, but these conditions are more common among women who are perimenopausal or menopausal. Often, the symptoms that occur as a result of perimenopause and menopause are similar to some effects of thyroid disease, which can mean that you might not recognize that what you're experiencing is caused by separate problems. Additionally, during the menopausal years, there are some special considerations when it comes to treatment of thyroid disease.

Overlapping Symptoms

While there are symptoms of thyroid disease and perimenopause/menopause that are distinct, many are so similar that you may not think of mentioning them to your doctor if you already have been diagnosed with one of the conditions.

Menstrual Irregularities

While changes to menstruation are expected with perimenopause, many women don't realize that they can also indicate thyroid disease.

  • Perimenopause: Menstrual changes can include irregular bleeding, such as heavier than usual menstrual flow, increased or decreased frequency of periods, irregular spotting, passing vaginal blood clots, cramping, light spotting after sex, and phantom periods (all the signs and symptoms of a menstrual period, but without bleeding).
  • Thyroid disease: Hypothyroidism can cause frequent, heavy periods, while hyperthyroidism can cause infrequent or unusually light periods.

Vaginal Issues

Due to the decline in estrogen levels in your body, you may notice vaginal dryness and irritation during the perimenopausal years, with worsening of these symptoms after menopause. This may make sex uncomfortable. Similarly, hypothyroidism can be associated with an increased risk of vaginal dryness and fragility of the vaginal tissue.

Sleep Problems

  • Menopause: Sleep difficulties that may arise during perimenopause include difficulty falling asleep, frequent waking (sometimes to urinate), or waking up early in the morning without feeling rested. Some women do not continue to experience sleep issues once they reach menopause, and if these issues continue, they are usually not as severe.
  • Thyroid disease: Hypothyroidism often causes sleepiness, while hyperthyroidism causes restlessness, and insomnia. Both conditions are associated with feeling as if you have not had enough sleep.

Weight Gain

  • Perimenopause: 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. After menopause, most women do not continue to experience the same degree of unintentional weight gain as they did during perimenopause.
  • Thyroid disease: Hypothyroidism is usually associated with weight gain or an inability to lose weight. Hyperthyroidism is associated with weight loss or an increase in appetite without a corresponding weight gain.

Mood Changes

  • Perimenopause: Women can experience a number of mood problems during perimenopause, such as irritability, rapid mood swings, extreme emotionality, anxiety, and depression. As with many of the other symptoms, mood tends to stabilize during menopause.
  • Thyroid disease: Hypothyroidism is usually associated with general apathy (decreased interest) and can also cause depression. Hyperthyroidism can cause anxiety, hyperactivity, and hypomania.

Hair and Skin Changes

  • Perimenopause and menopause: Hormonal changes can cause thinning hair on the head or body, as well as receding hair loss at the temples. Some women develop unwanted hair on the chin, upper lip, and abdomen. Thinner, drier skin and more prominent wrinkles can develop. These changes are more noticeable after menopause and can continue to worsen throughout the years of menopause.
  • Thyroid disease: Hypothyroidism can cause dry skin and hair, while hypothyroidism and hyperthyroidism can both cause thinning hair both on the head and body.

Temperature Sensitivity

  • Perimenopause: Women often experience hot flashes and night sweats during perimenopause, as well as a general feeling of feeling too hot all the time. These symptoms usually disappear after menopause, when most women often feel colder than usual.
  • Thyroid disease: Hypothyroidism causes a person to feel cold all the time, while hyperthyroidism can make people feel uncomfortably hot.

Energy and Concentration

  • Perimenopause: Women often experience occasional fatigue, lack of energy, or trouble concentrating during perimenopause, and this is largely thought to be related to sleep issues. Usually, these symptoms resolve during menopause.
  • Thyroid disease: Hypothyroidism causes fatigue and lack of energy, while hyperthyroidism can cause excessive and unfocused energy. Both hypothyroidism and hyperthyroidism can interfere with your ability to focus and concentrate.

Low Sex Drive

  • Perimenopause and menopause: Changes in hormone levels often interfere with sex drive, and this may improve with hormone replacement therapy.
  • Thyroid disease: Hypothyroidism may cause a diminished sex drive, which can also improve with treatment.

Changing Hormones

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 is defined as the years leading up to menopause, and it can begin as long as 10 years before you officially make this transition. Most women begin perimenopause in their forties, but some can begin during the late thirties.

The trigger for perimenopause is a decline in baseline levels of estrogen and progesterone. These hormonal change often cause symptoms, such as hot flashes and night sweats. As menopause approaches, your stock of viable eggs diminishes, your hormone levels cannot trigger ovulation, menstruation stops, and menopause occurs.

There are several types of thyroid disease. Regardless of their causes, of which there are many possibilities, they all result in a change in level of thyroid hormones in the body.

Given the overlapping symptoms, it's easy to assume that one condition is affecting the other. However, the connection is not, in fact, thought to be related to an interaction between thyroid hormones and the hormones that are involved in menopause.

Determining Your Diagnosis

If you experience symptoms that could be characteristic of perimenopause, menopause, and thyroid disease, you may need some diagnostic tests to clarify the cause of your symptoms.

Some diagnostic tests include:

  • Blood hormone levels: Your thyroid stimulating hormone (TSH), thyroxine (T3), and triiodothyronine (T4) are all screening tests for thyroid disease. Similarly, there are lab tests that can help diagnose menopause by measuring follicle stimulating hormone (FSH) and estradiol. Your doctor can interpret the results of these tests and should discuss them with you. Sometimes, hormone levels need to be repeated in a few months to identify changes in your hormone levels, which is more helpful in assessing disease than results obtained at only one point in time.
  • Imaging tests: Imaging tests that evaluate the structures in your neck, such as computed tomography scan (CT), magnetic resonance imaging (MRI), and ultrasound, can help identify a goiter, nodules, or cancer of the thyroid gland, all of which can cause hypothyroidism or hyperthyroidism.

Additive Health Effects

Some of the medical risks associated with menopause can occur with thyroid disease as well. These effects usually do not cause noticeable symptoms, but your doctor may do some additional tests to identify these problems.

Common health effects of menopause and thyroid disease include:

  • Lower bone density can occur with hypothyroidism, hyperthyroidism, and menopause.
  • Elevated cholesterol levels can occur with hypothyroidism, perimenopause, and menopause.
  • Heart-related problems, including rapid heartbeat, heart palpitations, and an irregular heartbeat can occur with hyperthyroidism and menopause.


If you have thyroid disease, you will likely need treatment. Many women do not need treatment for symptoms of perimenopause or menopause, as this stage of life is not an illness. Nevertheless, some of the symptoms that can interfere with your quality of life are treatable. And for some women, the effects of menopause can increase the risk of certain health problems.

Sometimes treatment for thyroid disease or estrogen hormone replacement can alleviate additive health effects of the conditions, but they may also require targeted treatment, such as cholesterol-lowering medications.

Thyroid Treatment Considerations

There are special considerations for women who have thyroid disease during menopause. These issues are not usually concerning during perimenopause.

If you are taking estrogen supplementation for symptoms of menopause, you may need to take a lower-than-usual dose of either your thyroid replacement medication or your estrogen medication because the hormones in each can interact, altering the effects of both medications on your body.

Another important consideration is that high thyroid levels (which can occur as a result of thyroid replacement therapy) can pose more health problems during or after the perimenopausal stage, with an increased risk of osteoporosis and arrhythmias (heartbeat irregularities).

Never stop taking or lower your dose of a prescribed medication without first speaking with your doctor.

A Word From Verywell 

The rate of hypothyroidism goes up significantly during perimenopause and after menopause. This is largely because thyroid disease is simply more common after age 40 and is generally a lifelong illness. While hypothyroidism and hyperthyroidism are both treatable, your treatment may need some adjustments throughout menopause.

Remember that menopause and thyroid disease are distinct conditions. Treatment of hypothyroidism or hyperthyroidism is the only way to manage thyroid disease. Since many of the symptoms of thyroid disease are similar to those of menopause, the additive effect can become intolerable if one of the conditions is not adequately addressed.

Complicating matters is the fact that you may actually develop thyroid disease during menopause. You should rest assured that when symptoms of perimenopause or menopause are more severe than expected, thyroid tests are usually ordered because thyroid conditions are fairly common at this age. 

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