Symptoms of thyroid issues and menopause are similar and can often lead to misdiagnosis and insufficient treatment. Here’s what you should look out for.
Perimenopause and menopause symptoms can closely resemble those of thyroid issues. Both may cause hot flashes , night sweats, difficulty sleeping, weight gain, and more. Furthermore, as the likelihood of hypothyroidism increases with age, many women are diagnosed with it around the same time they experience menopause. In fact, 12 to 20% of women over the age of 60 may have an underactive thyroid (1 ).
It’s common for menopause and thyroid issues to coexist, but because their symptoms overlap, it can be difficult to distinguish between the two–often leading to misdiagnosis or dismissal of patients' concerns. Untreated thyroid issues can lead to additional health problems and amplify menopause symptoms and risks. That’s why testing your thyroid function is important in identifying imbalances so you can properly manage your symptoms and overall health.
What is menopause? Menopause officially occurs when you’ve experienced 12 consecutive months without a menstrual period. There are three stages of menopause: perimenopause, menopause, and postmenopause.
Perimenopause typically begins 8 to 10 years before menopause (2 ). During this stage, your ovaries gradually release less estrogen and eventually stop producing eggs. Estrogen deficiency can lead to symptoms like irregular periods , hot flashes, vaginal dryness, and mood swings. Perimenopause can last several months or several years, with an average duration of four years (3 ).
After 12 consecutive months without a menstrual period, menopause is completed. The ovaries stop releasing eggs, and estrogen production significantly declines. Once you’ve entered this stage, you are considered postmenopausal. Low estrogen levels during this time increase your risk of osteoporosis and cardiovascular disease.
What is the thyroid gland? The thyroid is a butterfly-shaped gland located in the front of your neck. It produces hormones thyroxine (T4) and triiodothyronine (T3), which support metabolism, regulate body temperature, and ensure proper function of the heart, brain, kidneys, and reproductive system (4 ). The thyroid is regulated by the thyroid-stimulating hormone (TSH), which is secreted by the pituitary gland in the brain.
Thyroid disorders occur when the gland either underproduces or overproduces thyroid hormones. Thyroid issues are ten times more common in women than men.
Hyperthyroidism: An overactive thyroid, is rare and occurs when the thyroid gland produces too many hormones, causing metabolism to speed up (5 ). Hypothyroidism: An underactive thyroid, is more common and shares symptoms with menopause. It can even trigger early menopause (6 ). In hypothyroidism, the thyroid doesn’t release enough thyroid hormones, which slows the body’s metabolism. This can lead to fatigue, low mood, weight gain, and impaired concentration. Treating thyroid issues may relieve symptoms or prevent early menopause (before age 40 or in the early 40s) (7 ).
>>MORE: 6 Hormonal Imbalance Symptoms (and How to Manage Them)
Common symptoms of thyroid issues and menopause These shared symptoms make it hard to distinguish between thyroid dysfunction and menopause:
Fatigue Hot flashes Weight gain Difficulty sleeping or insomnia Mood swings or depression Hair thinning Irregular periods Reduced sexual desire Brain fog or memory issues Although hot flashes, weight gain, and mood swings are common symptoms of menopause, they may also be signs of hypothyroidism, or be caused by other conditions or lifestyle behaviors. Additionally, some thyroid medications may cause side effects that resemble menopause symptoms, such as sweating, difficulty sleeping, and headaches (8 ).
Due to these overlaps, women are often misdiagnosed or not adequately treated. It’s critical to test your thyroid and consult with your doctor.
Complications and risks Thyroid dysfunction can worsen health risks associated with menopause. Estrogen supports reproductive, bone, and cardiovascular health. When estrogen levels decline, bone loss accelerates, increasing the risk of osteoporosis (9 ). Similarly, too much thyroid hormone can cause the bones to lose calcium, further raising osteoporosis risk.
Menopause treatment and thyroid function Hormone replacement therapy (HRT) is commonly used to relieve menopause symptoms, but it may affect thyroid function, especially in individuals with hypothyroidism. Restoring estrogen in the body can influence the thyroid's ability to function properly. Oral HRT increases levels of proteins that bind to T4, reducing the amount of active T4 available to regulate metabolism. This may require adjustments to HRT treatment.
Testing thyroid function after starting oral HRT is recommended. Non-oral forms of HRT such as gels, sprays or patches typically do not affect T4 levels.
Some studies that suggest estrogen increases the body’s demand for thyroid hormones (9 ). However, more research is needed to understand the connection between these two hormones.
If you're undergoing estrogen treatment for menopause and also have hypothyroidism, it’s important for your doctor to regularly monitor your thyroid levels.
>>RELATED: What Causes Hormonal Imbalance?
Thyroid issues vs. menopause symptoms: the bottom line Menopause causes hormone imbalances , particularly a decline in estrogen, which can produce a wide range of symptoms. Thyroid imbalances, particularly hypothyroidism, can present with similar issues–such as weight gain, fatigue, and mood changes–making it difficult to distinguish between the two conditions.
However, some symptoms may provide clues:
Thyroid issues often cause metabolic changes and fatigue. Estrogen deficiency tends to impact sexual health, menstrual cycles, and fertility. Many women experiencing menopause-like symptoms may actually have undiagnosed thyroid conditions. While hypothyroidism can’t be prevented, early diagnosis and treatment can significantly improve quality of life.
Regular thyroid testing during perimenopause is a simple and effective way to identify thyroid disorders. A basic blood test to measure your levels of T3, T4, and TSH is all that's required (10 ). Discussing your symptoms with your healthcare provider will help you find the most accurate diagnosis and effective treatment plan.
In addition to testing, maintaining a healthy lifestyle through diet, exercise, stress management, and proper sleep, can help relieve your symptoms and support your overall health.
