Is It Perimenopause or a Thyroid Problem?

You’re irritable, anxious, you’ve gained weight, and you haven’t got a good night’s sleep in weeks. These are all symptoms of perimenopause, but they can also be a sign of thyroid disease–which can make menopause symptoms feel a lot worse. Perimenopause and menopause increase risk of thyroid disease, though there’s no evidence that one causes the other. Menopause and thyroid disease are intricately connected. Not only do symptoms overlap, but thyroid hormones, estrogen, and progesterone can affect one another and worsen symptoms.

Knowing what’s behind your symptoms is the key to better managing both thyroid problems and perimenopause symptoms. Here’s how to tell the two apart, and how keeping an eye on your thyroid can help guide your treatment…and massively boost your comfort level.

Hormone Changes During Perimenopause

Perimenopause and thyroid problems share several symptoms, which often makes them difficult to tell apart. As progesterone plummets, estrogen also decreases–but less drastically–triggering symptoms of estrogen dominance and negatively impacting thyroid health.

Perimenopause and menopause increase risk for thyroid issues–including both underactive and overactive thyroid.

Hypothyroidism (underactive thyroid) is caused by reduced thyroid hormone activity. Symptoms include low energy, brain fog, depression, menstrual changes, and weight gain.
Hyperthyroidism (overactive thyroid) results from an excess of thyroid hormone. Symptoms include anxiousness, or feeling irritable, increased heart rate, excessive sweating, trouble regulating body temperature, menstrual changes.

There are several root causes for an underactive thyroid, but the most common cause of hypothyroidism in the U.S. is Hashimoto’s thyroiditis. This is an autoimmune disease in which the immune system attacks the thyroid gland, and it becomes unable to make enough thyroid hormone.

What perimenopause and thyroid problems have in common:

Both hypothyroidism and perimenopause are associated with weight gain.

Perimenopause is essentially universal, and thyroid problems are very common–especially around the onset of menopause symptoms.

Both may cause issues with temperature control (feeling cold, hot flashes, etc.)

Fatigue and low energy are common with hypothyroidism and menopause.

Weight gain is a common side effect of both.

Both hypothyroidism and perimenopause trigger sleep disturbances.

Period changes or heavy bleeding are common.

Both hypothyroidism and perimenopause have a link with depression.

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Does Perimenopause Affect My Thyroid?

Although there’s no proof that perimenopause directly causes thyroid disease, changes in hormones like estrogen and progesterone affect overall hormone function–including your thyroid hormones.

Hormone imbalance and stress during perimenopause can reduce healthy thyroid function (1).

As progesterone decreases with perimenopause, you may notice more stress than usual. This means your adrenal glands pump out more cortisol to help you cope. But prolonged high cortisol levels (caused by chronic stress) make it harder for your liver to clear excess estrogen, which is already an issue during perimenopause.

This excess estrogen increases a type of protein, called thyroid-binding globulin (TBG), which thyroid hormone is attached to as it’s transported through your body (2).

Why are high TBG levels a problem? Thyroid hormone is inactive when bound to TBG–meaning, it can’t do its job. It must first be separated from TBG for your cells to use it. In lab tests, this is measured as “free” T4 (FT4) and FT3.

Adrenal stress, excess estrogen, and hormonal birth control can all increase levels of TBG and reduce thyroid function.

7 Thyroid and Perimenopause Symptoms to Watch

Estrogen hormones and thyroid hormones communicate with many organs and tissues in your body. Both of these types of hormones affect menstrual cycles, metabolism, body temperature, mood, and energy levels.

Because of this, symptoms of thyroid problems and perimenopause often overlap and have a compounding effect. Here are common signs and symptoms in perimenopause, and how they differ from thyroid problems.

Read: The Big Signs of Potential Thyroid Problems

1. Changes in Menstruation

Perimenopause is usually associated with irregular periods, heavy periods, or missed periods altogether. Menopause is defined as 12 months after your last period.

Hyperthyroidism can also result in irregular menstrual cycles, and hypothyroidism may cause heavy bleeding, very light bleeding, and changes in the frequency of cycles.

2. Sleep Disturbances

During perimenopause, many women complain of falling asleep normally, but waking again 3 to 4 hours later, unable to go back to sleep. This can be due to much lower progesterone levels, which allows cortisol levels to rise slightly during the night when they should be low. This rise in cortisol prompts wakefulness.

Hyperthyroidism typically causes insomnia, while hypothyroidism results in an increased need for sleep. Women with hypothyroidism usually wake still feeling tired and groggy, no matter how much sleep they get.

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3. Energy and Fatigue

One common side effect of perimenopause is reduced energy and feelings of fatigue. Hypothyroidism also causes symptoms of fatigue, in addition to poor concentration and brain fog.

Hyperthyroidism, or an overactive thyroid, can result in high energy, but it’s not generally an energy that makes you feel good. On the contrary, hyperthyroid can make you feel scattered or overly anxious.

4. Feeling Hot + Cold

Women who are perimenopausal or menopausal may experience hot flashes, in addition to feeling cold sometimes for seemingly no reason.

Hypothyroidism may make you feel cold, and hyperthyroidism can make you feel hot, and like your heart is racing.

5. Weight Gain, Especially Around Your Abdomen

Most women experience weight gain during perimenopause. Weight gain appears to be triggered mainly by estrogen levels that are higher than normal and progesterone levels that are too low. High estrogen causes weight gain via insulin resistance, which changes how your body responds to insulin, and increases fat storage especially around the belly.

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

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6. Depressed Mood

Hormones regulate much of your emotions and mood. Perimenopause is associated with mood swings, and, some studies show menopause increases the risk of depression (3).

Hypothyroidism can result in depression, while hyperthyroidism may lead to anxiety.

7. Digestive Problems

An underactive thyroid, or hypothyroidism, often causes constipation, while an overactive thyroid frequently causes diarrhea (4).

Perimenopause itself doesn’t cause digestive issues, but some studies show that changes in hormones may influence the occurrence, or severity, of abdominal pain and discomfort. This may happen even if you haven’t been diagnosed with IBS (5).

How Do I Know If It’s Perimenopause or Thyroid Problems?

Thyroid disorders are common around the time of menopause, or just before, during perimenopause. But many women overlook their thyroid problems because the symptoms are so similar to menopause and it seems like they’re “normal” for that age.

How can you see through the mimicry? Don’t worry, simple blood tests can help rule out thyroid disease–both hyper- and hypothyroidism. Regardless of your test results, however, it’s important to find a qualified holistic medicine doctor to help you manage or resolve your symptoms.

Watch to learn more: How to Control Your Thyroid Naturally

Thyroid Disorders Are Very Common

Up to 12% of adults have undiagnosed subclinical hypothyroidism (6). And considering that women are 5 to 8 times more likely than men to experience thyroid problems–this is a large number of women. Since many of the signs of hypothyroidism are so common, it’s easy to dismiss them.

It’s important to work with a holistic medicine doctor and get a blood test if you’re experiencing changes in weight, reduced concentration, or anything else that you feel isn’t normal. You know your body best, and it’s imperative you don’t dismiss how you’re feeling.

A holistic medicine doctor will likely check your thyroid gland for any irregularities or nodules, ask questions about your symptoms, and then recommend diagnostic testing based upon your individual circumstances.

Effective treatments are available for most thyroid problems, whether it’s medication, diet and lifestyle changes, and/or supplements to support thyroid function.

How to Control Your Thyroid Naturally

Should I Get My Hormones Testing During Perimenopause?

During perimenopause, some hormones can fluctuate unpredictably day to day. Despite this, hormone testing helps to reveal other underlying issues, including thyroid disease.

Many factors alter hormone balance, including diet, stress, emotions, sleep, and relationships. All of these compound over time, leading to dysfunction.

Tests a holistic medicine doctor may recommend during perimenopause include:

Complete blood count (CBC)
Comprehensive metabolic panel (CMB)
Cholesterol
Hemoglobin A1c
Vitamin C
Iron
FSH
LH
DHEA-S
SHBG (a protein that “binds” estrogen and testosterone)

Blood tests are useful for measuring thyroid markers. Urine and saliva tests are also useful because they reflect active forms of hormones like progesterone, cortisol, and estrogen. Urine can also provide more info about different kinds of estrogen metabolites to see how your body processes excess estrogen.

An integrative or holistic medicine provider can help you navigate complex hormone imbalance issues such as hypothyroidism. My integrative clinic, CentreSpringMD accepts patients virtually, or in-office if you’re local to the Atlanta area. Click to learn more.

Holistic Medicine for a Healthy Thyroid During Menopause

The risk of thyroid issues increases during perimenopause and menopause. Thyroid problems often mimic what are often considered “normal” symptoms of perimenopause, which can make them tricky to identify.

It’s important to consult a qualified holistic medicine doctor if you begin to feel difficulty concentrating, fatigue, or weight gain that is more than normal. Getting the right diagnosis and treatment for any thyroid problems is key to effectively managing both perimenopause comfort and thyroid function for women.

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