Fatigue, hot flashes, insomnia—could it be perimenopause, or is it your thyroid?

As women, we’re taught more about getting our first period than we ever learn about menopause—and there’s even less discussion around perimenopause. Equally transformative, the menopause shift is a major life transition that marks the end of your fertile years. And just like that first menstrual period, there’s a lot that happens leading up to it. You’ll likely experience fatigue, hot flashes, night sweats, insomnia, hair loss and mood swings—plus a litany of other symptoms. But this laundry list of unpleasantness can also mask a thyroid condition… if you don’t know what to look for.

Because perimenopause and thyroid disease often occur during the same phase of a woman’s life, they can be confused due to similar symptoms.

When the thyroid gland produces too much or too little thyroid hormone, it can cause many of the same symptoms seen in perimenopause, leaving many women to wonder what’s going on—and leaving many thyroid conditions to progress undiagnosed. In fact, up to 60% of people with thyroid disease are unaware of their condition.

What is perimenopause?

Perimenopause is the transitional stage, like the beginning of puberty, that leads up to menopause, which is actually marked as the particular point in time when you have not had a period for 12 consecutive months. During perimenopause, estrogen and progesterone levels gradually decline as your ovaries’ egg supply naturally wanes. This causes your periods to become less regular, while other symptoms of menopause may start to appear.

Perimenopause and its symptoms can start as early as your mid-30s and can last for 2 to 10 years until you actually reach menopause—typically around the same age as when your mother went through it.

What does the thyroid do?

Your thyroid—a little butterfly of an organ located in the middle of the lower neck—can be a friend or foe. When working properly, it produces hormones that regulate your metabolism, body temperature, heart rate, brain, kidney and reproductive system, and influences growth, development, muscle strength and appetite—managing every cell, tissue and organ in your body to keep them chugging away. When out of whack and producing too much or too little hormones, the thyroid can wreak havoc on just about every part of your life. Just like perimenopause.

The two most common forms of thyroid disorders are hyperthyroidism and hypothyroidism.

Graves’ disease or viral thyroiditis are conditions where your thyroid is overactive and produces too much hormone, whereas Hashimoto’s disease is when your thyroid is underactive and produces too little hormone. (Thyroid cancer is very rare and can have symptoms of both, but is most often accompanied by a lump or nodules appearing on your neck, so see your care provider right away if you notice these changes).

Shared symptoms of perimenopause and thyroid disease

“Symptoms of hypothyroidism can be confused with symptoms due to the menopause transition,” says Dr. Ekta Kapoor, MBBS, an endocrinologist in the Menopause and Women’s Sexual Health Clinic at the Mayo Clinic in Rochester, Minnesota. Likewise, symptoms of an overactive thyroid. In addition to the current discomforts, mistaking the symptoms of thyroid disease for perimenopause can have long term consequences. Understanding what your symptoms really represent is the first step in protecting your long term health.

Some of the many common shared symptoms of perimenopause and thyroid disease include:

Causes of perimenopause and thyroid disease

The link between thyroid disease and perimenopause conditions can cause one to worsen the other. During perimenopause, estrogen levels fluctuate, affecting thyroid hormone levels. The risk of thyroid disease for women is about 10 times higher than for men. Thyroid problems are significantly more common in women, possibly due to the relationship between estrogen and how the thyroid functions. In a 2011 study published in the Journal of Thyroid Research, researchers reported that there is evidence that “estrogen may have direct actions in human thyroid cells.” But more research is needed to determine how this actually happens.

There are several conditions that can bring on thyroid disease:

• Autoimmune diseases
• Inflammation from a viral or bacterial infection
• Nodules on the thyroid
• Cancerous tumours
• Medical treatments—radiation therapy, thyroid surgery and some medications
• Genetic disorders

It is important to note that pregnancy can cause thyroid problems to start or get worse. And if untreated, it can cause other problems for both mama and baby, including miscarriage, premature birth, preeclampsia and excess bleeding after delivery.

Diagnosis

According to the American Association of Clinical Endocrinologists (AACE), millions of women with menopausal-like symptoms—even those taking estrogen—may be suffering from undiagnosed thyroid disease. To put that in perspective, 35% of women between the ages of 35 and 52 are experiencing perimenopause—and 35% of them also have a thyroid condition.

Simple blood tests are usually all that is needed to diagnose whether the symptoms are due to perimenopause or thyroid disease—or both. Your levels of follicle stimulating hormone (FSH) and estrogen (estradiol) can reveal if you are in perimenopause. And separate blood tests that measure levels of thyroid stimulating hormone (TSH) and other thyroid hormones such Free T3 and T4 can help determine if you have thyroid disease—though note that there is a wide range of what is considered ‘normal’ here, versus what is considered functionally optimal. Talk to your doctor about the range that works best for you, as having a subclinical problem (outside of the optimal range, but within the normal range) can still mean you’ll have tiresome symptoms.

Regular bone density screening tests and hormone testing also can help with early detection of osteoporosis—a condition where bone density is reduced—which can occur during both perimenopause and thyroid disease as estrogen levels decrease. The onset of osteoporosis is one of the dangers of letting thyroid conditions go undiagnosed.

Treatment

Your healthcare provider can prescribe and adjust thyroid treatment based on your current needs, in addition to hormone replacement therapy during perimenopause and menopause. A study published in the journal Climacteric states that the decision to use hormone therapy for menopause should be individualized, especially in women with thyroid disorders such as hypothyroidism.

As their symptoms overlap, treating the two can have commonalities as well:

• Hypothyroidism is usually treated with prescription oral thyroid hormone medication to replenish the supply.
• Hyperthyroidism treatment options include medications that slow down the production of thyroid hormones. Other treatments include radioactive iodine and surgery.
• Hormone replacement therapy (HRT) can help reduce some symptoms associated with perimenopause.
• Bone density scans to monitor bone strength, vitamin D supplements and a diet high in calcium in addition to weight-bearing exercises can stave off further osteoporosis and promote bone health.
• Lubrication or progesterone cream can help with vaginal dryness.
• Antidepressants and counseling can help with depression.
• Meditation, relaxation and aromatherapy may help to diffuse the anxiety and irritability that can accompany mood swings.
• Maintaining a healthful sleep routine can help with insomnia. Sometimes supplements like magnesium, glycine and sleep aids can really make a difference, so talking to your doctor or naturopath can also help.
• Also talk to your doctor about eliminating gluten from your diet, which can be very helpful in treating Hashimoto’s or other autoimmune thyroid conditions specifically.
• And generally, getting enough exercise and limiting alcohol and coffee consumption may help with all symptoms.

Sources:

Santin AP, Furlanetto TW. Role of estrogen in thyroid function and growth regulation. Journal of thyroid research. 2011. doi:10.4061/2011/875125

Uygur MM, Yoldemir T, Yavuz DG. Thyroid disease in the perimenopause and postmenopause period. Climacteric. 2018 Dec;21(6):542-548. doi: 10.1080/13697137.2018.1514004

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