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Understanding the Difference between Thyroid Issues and Menopause

May 21, 2024 • read

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Understanding the Difference between Thyroid Issues and Menopause

The first wrinkles and gray hairs that appear during middle age — seemingly out of nowhere — can be surprising. But for women, the hormonal shifts that accompany this period can be even more transformative.

This time period can also be confusing, especially if hormonal shifts overlap with a thyroid disorder. And, given that both menopausal symptoms and thyroid issues can present similarly and increase with age, it can be hard to detangle the two.

Here’s what you should know about each of these conditions and how to tell which one you’re dealing with.

Causes and symptoms of thyroid issues

Your thyroid gland is a powerhouse in your body. It regulates your metabolism, speeding up or slowing down your heart rate, brain function, and digestion, depending on the hormones it secretes. So when something goes wrong with your thyroid, the physical consequences can be far-reaching.

About one in eight women will develop a thyroid problem in their lives. These issues fall into one of two camps, either hyperthyroidism, which is when your thyroid produces too many hormones, or hypothyroidism, which is when it produces too few. The potential causes of the second include: 

  • Hashimoto’s disease
  • Inflammation of the thyroid, also known as thyroiditis
  • Previous radiation or surgery to the thyroid gland
  • Congenital (from birth) hypothyroidism
  • Postpartum hypothyroidism 
  • Iodine deficiency (rare in the Western World)

Symptoms may vary depending on the duration and severity of thyroid hormone abnormality. With hypothyroidism, you’re most likely to see symptoms such as:

  • Weight gain
  • Brain fog
  • Depressed mood
  • Increased need for sleep
  • Low energy
  • Hair loss or hair thinning
  • Constipation
  • Feeling cold
  • Dry skin
  • Slowed heartbeat
  • Heavy or irregular periods

Hyperthyroidism, or overactive thyroid, is most frequently the result of an autoimmune disease called Graves disease. Less commonly, it’s caused by:

  • Toxic nodular goiter (enlarged thyroid gland)
  • Thyroiditis (inflammation triggered by certain medications, pregnancy, viral infections, or radiation for example) 
  • TSH-secreting pituitary tumor 
  • Treated with too much thyroid hormone

Because the increase in hormonal output causes your metabolism to speed up, hyperthyroid symptoms often include:

  • Weight loss despite a normal appetite
  • Heat intolerance or hot flashes
  • Increased frequency of bowel movements
  • Increased irritability
  • Nervousness or anxiety
  • Light, irregular, or infrequent periods
  • Rapid or irregular heartbeat

The most common symptoms of menopause and how age factors in

Although it may feel like an eternity, menopause is a moment in time. More precisely, it marks 12 consecutive months since your last menstrual period and on average, women experience it around age 51

However, the lead-up to menopause, known as perimenopause, is marked by declining estrogen levels and can last up to a decade.

As a result, many women begin experiencing symptoms of perimenopause between 40 and 44. The most common include:

  • Changes to your menstrual cycle including longer or shorter cycle lengths, heavier, lighter, or more irregular periods.
  • Hot flashes and night sweats
  • Sleep issues including difficulty falling asleep or staying asleep
  • Mood changes — especially low mood, depression, and irritability
  • Brain fog or difficulty concentrating, or memory issues
  • Genitourinary symptoms such as recurrent UTIs, vaginal dryness, and pain during and following sex.
  • Low energy
  • Weight gain

How to diagnose a thyroid issue

Because they can be non-specific, symptoms alone aren’t enough to diagnose a thyroid disorder.

Instead, you’ll need a blood test to measure your levels of thyroid-stimulating hormone (TSH). This is the hormone your pituitary gland produces to prompt your thyroid to increase its output. High levels of TSH indicate your thyroid isn’t functioning as well as it should be. In contrast, lower levels of TSH could mean your thyroid is working too hard. 

Once test results confirm that your TSH levels are either elevated or lower than expected, the next step is to measure the amount of triiodothyronine (T3) and thyroxine (T4) hormones your thyroid is producing. High levels of T3 and T4 circulating in your blood may indicate hyperthyroidism, while the opposite may signal hypothyroidism.

Thyroid testing may seem simple enough; however, you need a healthcare professional to interpret your results in conjunction with any presenting symptoms. Thyroid issues have the potential to cause serious health problems if they’re not dealt with appropriately. If you think you have a thyroid issue, speak to your healthcare provider to avoid missing something important. 

How to interpret your thyroid test results

In most adults, TSH levels between 0.45-4.50 mIU/L (milli-international units per liter) are considered normal. Despite this, medical guidelines only recommend treatment for TSH levels above 10 mIU/L.

Falling outside the healthy range but below treatment cutoffs doesn’t necessarily mean your thyroid is dysfunctional. After all, “normal” varies from person to person. However, you may benefit from treatment if you’re also experiencing the symptoms outlined above.

It’s important to speak to a healthcare provider to ensure your hormone levels are properly balanced. Depending on your test results, they can tailor your treatment to your TSH levels so you can function optimally. 

Here are the patterns for different thyroid designations: 

TSH levels T3 T4 Diagnosis
Normal Normal Normal Euthyroid
Low  Normal  Normal  Subclinical hyperthyroidism
Low or undetectable  High or normal High or normal Hyperthyroidism
Normal or high  High High TSH-mediated hyperthyroidism
High Normal Normal Subclinical hypothyroidism
High Low Low or normal Hypothyroidism

Diagnostic tests for menopause

Traditional symptoms of menopause like menstrual changes, vaginal dryness, and hot flashes are some of the most helpful for diagnosing the condition. After all, they’re both hallmark symptoms of a decline in estrogen and hard to miss.

However, estrogen receptors throughout the body mean that decreasing estrogen levels can trigger a cascade of perimenopausal symptoms. These can include more general symptoms, like brain fog or joint pain, which are harder to attribute definitively.

If it’s unclear what’s causing your symptoms, measuring hormone levels through blood testing can sometimes help. Keep in mind that hormone levels vary markedly and are unreliable guides to menopausal status alone. 

During your reproductive years, your body primarily produces estrogen in the form of estradiol. Estradiol levels tend to remain unchanged or raise with age until the transition and can be preserved into late perimenopause. So, if a blood test indicates your levels of it are low, it’s likely your symptoms are related to perimenopause.

In contrast, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are likely to increase as you enter the less fertile period or perimenopause. Consequently, rising levels of them in your blood are a good indication that you’re in or nearing perimenopause.

Comparing thyroid issues and menopause

All women will go through menopause. Symptoms begin to crop up for many during their 40s, accelerate in their 50s, and may linger into their 60s. This same timeframe also coincides with a rise in the rates of thyroid dysfunction — especially hypothyroidism, which affects women seven to 10 times more frequently than men.

To further muddy the waters, cognitive issues, sleep disorders, and weight gain are some of the most common symptoms women face when experiencing thyroid issues and menopause. Even hot flashes aren’t a clear indicator. While they’re most likely to be a product of the menopausal transition, they can also be a symptom of an underlying medical condition like hyperthyroidism. 

With so much overlap between the two, it’s little wonder that the average woman has trouble attributing her symptoms to menopause or thyroid issues. Whatever their cause, however, symptoms aren’t likely to disappear on their own.

Most hormonal issues require intervention which is why it’s so crucial to speak with a doctor if you’re experiencing symptoms. Connecting with a medical professional ensures you receive the appropriate testing and a clear diagnosis. From there, you can discuss the treatment options that will best support your goals.

If you think you’re experiencing symptoms related to your thyroid or to menopause, help is available. Speak with a primary care providers on Maple today to discuss the testing and treatment options that are right for you.

Information presented here is for educational purposes, and not to replace the advice from your medical professional. Virtual care is not meant for medical emergencies. If you are experiencing an emergency like chest pain or difficulties breathing, for example, please call 911 or go to your nearest emergency room.

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