The Link Between Thyroid Disease and Menopause

Perimenopausal and postmenopausal women are at increased risk of thyroid disease, but there is no clear evidence that former causes the latter. Still, menopause and thyroid disease are intertwined. Not only do their effects overlap, but thyroid hormones and estrogen can influence each other and exacerbate symptoms.

Whether you already have an established diagnosis of thyroid disease when you reach menopause or you develop it during this new period of your life, it can be tricky to pinpoint which of the two issues is causing symptoms such as trouble sleeping and weight changes.

Furthermore, the medical management of thyroid disease can have an impact on menopausal symptoms, and vice versa. Tests that measure your thyroid hormones can help sort out the cause and guide your treatment.

Impact of Hormonal Changes

Menopause is a normal physiologic process caused by a gradual decline in estrogen that occurs over the course of years. (Early menopause can also occur due to certain medical treatments.)

Thyroid disease can occur due to under-activity or overactivity of the thyroid gland in the neck.

• Hypothyroidism is a medical condition caused by diminished thyroid hormone activity.
• Hyperthyroidism is an affliction caused by an excess of thyroid hormone.

It can also develop due to under activity or overactivity of the pituitary gland or the hypothalamus in the brain (which release hormones that stimulate the thyroid gland). Conditions like a goiter (enlarged thyroid), a thyroid tumor, or disease can lead to hypothyroidism or hyperthyroidism.

These thyroid hormone regulators, especially the hypothalamus, also influence estrogen activity throughout a woman's life, including during the perimenopausal phase.

Shared Symptoms

Since thyroid disease includes a range of conditions characterized by low or high thyroid hormone activity, related symptoms vary.

From the time you start to have the earliest signs of perimenopause to years after menopause, you can experience weight changes, sleeping difficulties, mood swings, vaginal dryness, urinary infections, and more.

Having both thyroid disease and going through or having reached menopause means that you may very likely be experiencing a wide range of symptoms, many of which are shared and, therefore, worsened by this "dual diagnosis."

Changes in Menstruation

Perimenopause is typically associated with irregular periods and/or missed periods. Menopause, by definition, is a complete cessation of periods.

Hyperthyroidism can result in irregular or frequent periods, while hypothyroidism may cause increased or decreased bleeding and/or frequency of your periods.

Energy Level

Generally, perimenopause and menopause are associated with low energy, as is hypothyroidism.

Hyperthyroidism often results in high energy, but it's typically pretty unfocused and unproductive.

Sleep

Women may have trouble falling asleep and staying asleep during perimenopause. Many women complain of waking up too early in the morning after menopause.

Hyperthyroidism typically causes insomnia, while hypothyroidism results in an increased need for sleep.

Weight Changes

Most women experience weight gain during perimenopause with stabilization of weight after menopause.

Hypothyroidism often causes weight gain, and hyperthyroidism usually leads to weight loss.

Mood

Perimenopause is associated with mood swings, and menopause may increase the risk of depression.

Hypothyroidism can result in depression, while hyperthyroidism may lead to anxiety, or rarely, an elevated, happy mood.

Body Temperature

Women who are perimenopausal may feel cold all the time. But women can also experience hot flashes during the perimenopausal years, and sometimes after menopause too.

Hypothyroidism may make you feel cold, and hyperthyroidism can make you feel hot and sweaty.

Digestive Problems

Hyperthyroidism may cause diarrhea, and hypothyroidism often causes constipation.

Women who have digestive issues like inflammatory bowel disease (IBD) may experience changes in symptoms during perimenopause and after menopause.

Diagnosis

When it comes to determining whether menopause, thyroid disease, or both are contributing to your symptoms, diagnostic tests are helpful.

Thyroid Testing

Diagnosis of thyroid disease requires blood tests that measure thyroid hormones.

Sometimes, these blood tests are followed up with imaging tests of the brain and/or neck to visually evaluate the brain or thyroid gland.

Hormone Level Testing

If your blood tests don't show any evidence of thyroid hormone dysfunction, then your symptoms are likely caused by perimenopause, menopause, or a gynecological issue that alters hormones.

Menopause is not an illness. Nevertheless, it is something that has clinical diagnostic criteria, which relates to a woman's history of the symptoms and their correlation to her age.

If your menopausal or perimenopausal symptoms are following an atypical pattern, you may need blood tests to assess your estrogen levels or imaging tests so your medical team can visualize your uterus or ovaries.

A uterine or ovarian tumor may cause changes in hormone levels, with effects that may mimic perimenopause or menopause.

Additional Tests

If you have been diagnosed with perimenopause, menopause, or thyroid disease, your healthcare provider may screen you for complications.

You may have bone X-rays to search for early osteoporosis. While osteoporosis (frail, thin bones) doesn't produce noticeable symptoms, it increases the risk of bone fractures. Menopause, hypothyroidism, and hyperthyroidism can all increase the risk of osteoporosis.

And you will likely have your blood pressure monitored for the detection of early hypertension. Menopause and hyperthyroidism are both associated with an increased risk of cardiovascular disease, including high blood pressure and coronary artery disease.

These issues lead to serious consequences, including heart attack, stroke, and heart failure.

You might also be asked about your mood so your medical team can identify signs of depression or anxiety.

Finally, further testing may be needed if there is a serious concern regarding menopause or thyroid disease. For example, you might need a biopsy of your thyroid gland if neck swelling or the appearance on an imaging test raises the suspicion that you could have a tumor.

Treatment

If you have thyroid disease, you need to be treated:

• Hypothyroidism is often treated with prescription thyroid hormone supplements.
• Hyperthyroidism may need to be treated with medication, surgery or radiation.

When you are treated for your thyroid disease, your medical team will monitor your thyroid hormone levels to assess the effects of the treatment. Of course, keeping an eye on your symptoms (and reporting any new ones or worsening of existing symptoms) is important too.

Regardless of your thyroid status, you may benefit from estrogen replacement therapy, which can help alleviate the effects of perimenopause or menopause. Keep in mind that you might not need this type of hormonal treatment forever. Some women use estrogen supplementation during the symptomatic phase of perimenopause and menopause and are able to discontinue treatment, while others need treatment for the long term.

Symptomatic Treatment

If you develop effects such as hypertension, vaginal dryness, urinary infections, insomnia, mood changes, or osteoporosis, you may need treatment for these symptoms in addition to your thyroid treatment or estrogen hormone supplementation.

For example, women who have depression may benefit from taking an antidepressant. And osteoporosis may be treated with prescription therapy like Fosomax (alendronate), which helps prevent bone breakdown.

A Word From Verywell

Symptoms related to menopause vary in severity and duration from one woman to another. Whether you have thyroid disease or not, it is important to describe your symptoms to your healthcare provider and not to assume that it's all "just menopause" or that you will get over it.

Once you're diagnosed, there are treatments that can reduce your health risks and make you more comfortable. Keep in mind that when it comes to treating your perimenopausal and menopausal symptoms, what's right for you may not be the same as what's right for your mom, sister, or friend.