Perimenopause or thyroid problem? Symptoms, causes, treatment

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As women, we are taught more about first periods than about menopause – and there is even less discussion around perimenopause. Just as transformative, going through menopause is a major life transition that marks the end of your fertile years. And just like that first menstrual period, there’s a lot going on before it. You’ll likely experience fatigue, hot flashes, night sweats, insomnia, hair loss and mood swings, along with a litany of other symptoms. But this long list of annoyances 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 lifethey 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 wondering what’s going on and leaving many thyroid conditions to progress undiagnosed. In reality, up to 60% of people with thyroid disease unaware of their condition.

What is perimenopause?

Perimenopause is the of transition stage, such as the onset of puberty, which leads to menopause, which is actually marked as the particular time when you haven’t had a period for 12 consecutive months. During perimenopause, estrogen and progesterone levels gradually decline as the egg supply from your ovaries naturally decreases. It makes your periods less regular, while others symptoms of menopause may start to appear.

Perimenopause and its symptoms can begin as early as your mid-thirties and can last anywhere from 2 to 10 years until you actually hit menopause, usually around the same age when your mother went through it.

What does the thyroid do?

Your thyroid-a little organ butterfly located in the middle of the lower neck – can be friend or foe. When working properly, it produces hormones that regulate your metabolism, body temperature, heart rate, brain, kidneys and reproductive system, and influence growth, development, muscle strength and appetite, managing every cell, tissue and organ in your body to suffocate them. a way. When it’s out of whack and producing too many or too few hormones, the thyroid can wreak havoc in just about every aspect 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 producing too many hormones, while Hashimoto’s disease this is when your thyroid is underactive and producing too few hormones. (Thyroid cancer is very rare and can have symptoms of both, but is most often accompanied by a lump or lumps appearing on your neck, so see your healthcare provider right away if you notice these changes).

Common Symptoms of Perimenopause and Thyroid Disease

“Symptoms of hypothyroidism can be confused with symptoms due to the transition from menopause,” explains Dr. Ekta Kapoor, MBBS, an endocrinologist at the Mayo Clinic Menopause and Women’s Sexual Health Clinic in Rochester, Minnesota. Likewise, the symptoms of an overactive thyroid. In addition to current discomforts, confusing symptoms of thyroid disease with perimenopause can have long-term consequences. Understanding what your symptoms really represent is the first step to 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 Perimenopausal Conditions can aggravate each other. During perimenopause, estrogen levels fluctuate, affecting thyroid hormone levels. The risk of thyroid disease in women is about 10 times higher than in men. Thyroid problems are much more common in women, possibly due to the relationship between estrogen and thyroid function. In one 2011 study published in the Thyroid Research Journal, the 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.

Several conditions can lead to thyroid disease:

  • Autoimmune diseases
  • Inflammation due to viral or bacterial infection
  • Nodules on the thyroid
  • Cancerous tumors
  • Medical treatments – radiation therapy, thyroid surgery and certain medications
  • Genetic Disorders

It is important to note that pregnancy can cause or worsen thyroid problems. And if left untreated, it can cause other problems for both mom and baby, including miscarriage, premature birth, preeclampsia, and excessive bleeding after delivery.


According to the American Association of Clinical Endocrinologists (AACE), millions of women with menopausal-like symptoms, even those taking estrogen,may have undiagnosed thyroid disease. To put that into perspective, 35% of women between the ages of 35 and 52 are going through perimenopause, and 35% of them also have thyroid disease.

Simple blood tests are usually enough to diagnose whether symptoms are due to perimenopause or thyroid disease, or both. Your follicle-stimulating hormone (FSH) and estrogen (estradiol) levels can tell if you’re in perimenopause. And separate blood tests that measure levels of thyroid-stimulating hormone (TSH) and other thyroid hormones such as free T3 and free T4 can help determine if you have thyroid disease, but note that it There is a wide range of what is considered “normal” here, versus what is considered functionally optimal. Discuss with your doctor which range is best for you, as a subclinical problem (outside the optimal range, but within the normal range) can still mean that you will have distressing symptoms.

Regular bone density screening and hormone testing can also help in the early detection of osteoporosis – a condition in which bone density is reduced – which can occur both during perimenopause and thyroid disease when the estrogen levels decrease. The onset of osteoporosis is one of the dangers of not diagnosing thyroid problems.


Your healthcare provider can prescribe and adjust thyroid therapy 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, treatment for the two may also have some commonalities:

  • Hypothyroidism is usually treated with oral prescription thyroid hormone medications to replenish the supply.
  • Treatment options for hyperthyroidism include medications that slow the production of thyroid hormones. Other treatments include radioactive iodine and surgery.
  • hormone replacement therapy (HRT) may help reduce some symptoms associated with perimenopause.
  • Bone density scans to monitor bone strength, Vitamin D supplements and a diet rich in calcium in addition to weight-bearing exercises, they can prevent osteoporosis and promote bone health.
  • Lubrication or a progesterone cream can help with vaginal dryness.
  • Antidepressants and counseling can help with depression.
  • Meditation, relaxation and aromatherapy can help diffuse the anxiety and irritability that can accompany mood swings.
  • Maintain a healthy sleep routine can help with insomnia. Sometimes supplements like magnesium, glycine, and sleeping pills can really make a difference, so talking to your doctor or naturopath can help as well.
  • Also talk to your doctor about eliminating gluten from your diet, which can be very helpful in the specific treatment of Hashimoto or other autoimmune thyroid conditions.
  • And generally, getting enough exercise and limiting alcohol and coffee intake can help relieve all symptoms.


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 during perimenopause and postmenopausal period. Climacteric. 2018 Dec;21(6):542-548. doi: 10.1080/13697137.2018.1514004

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