Is it menopause or a thyroid problem?

Yahoo

2 days ago

You're exhausted, irritable and your jeans don't fit. Your periods are MIA, and your hair is thinning. These are all tell-tales that the big M, as in menopause, is approaching. But — surprise — those same symptoms could actually signal trouble with your thyroid, a butterfly-shaped gland in your neck that produces hormones regulating metabolism, energy, heart rate and more.
It's no shock you assume perimenopause — the timing and the symptoms line up. According to a 2025 paper in the journal Women (Basel), perimenopause typically begins in your mid-to-late 40s and lasts an average of 4 to 7 years, though it can stretch to an unrelenting 14 years (!). And thyroid issues? They often peak during midlife too.
Plus, thyroid issues aren't exactly rare. About 20 million Americans have some thyroid issue — but women are 5 to 8 times more likely to be affected. According to the same report by the American Thyroid Association, 1 in 8 women will develop a thyroid condition during their lifetime. That means it's entirely possible to experience both menopause-related symptoms and signs of thyroid dysfunction at the same time.
Who says we can't have it all? Sigh.
We turned to leading endocrinologists and women's health experts to decode the mystery: How can you tell if your midlife misery is hormonal havoc from perimenopause — or a thyroid that's gone rogue? Here's what they want every woman to know.
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Menopause vs. thyroid problems: Why symptoms overlap
Not only can thyroid disorders and menopause strike around the same time — and with many of the same signs — those overlapping symptoms are what doctors call "nonspecific." That means they could indicate several different conditions. "These are incredibly common symptoms and, by themselves, don't point clearly to any one diagnosis," says Dr. Scott Isaacs, an endocrinologist and obesity specialist at Emory University School of Medicine in Atlanta.
This convergence and symptom ambiguity creates a perfect storm of confusion. A 2023 report in the journal Cureus underscores this, noting that symptoms of menopause are frequently mistaken for hypothyroidism, which can go unrecognized and is often misattributed to menopause.
In fact, it can be so difficult to tell the difference between root causes that in 2024, the European Menopause and Andropause Society released a position paper sounding the alarm for increased awareness among health care providers.
The stakes are real for patients and doctors alike. "We must make sure to rule out serious conditions, but also avoid overdiagnosis and unnecessary medication, especially since thyroid hormone therapy — levothyroxine — is often initiated for people with normal thyroid levels, which doesn't help symptoms, and can even cause harm," says Isaacs. He adds that clinicians must use caution: Identify thyroid disease that truly needs treatment, without reflexively prescribing medication when it's not warranted.
Thyroid and menopause symptoms: What to watch for
Here are two thyroid disorders that can masquerade as menopause — and the symptoms they share.
Hyperthyroidism: When your thyroid works too hard
Hyperthyroidism, also called overactive thyroid, happens when your thyroid gland pumps out more hormones than your body needs. This excess revs up your metabolism and can leave you feeling jittery, sweaty and sleepless — which might sound a lot like menopause.
And here's something many women don't know: In some cases, untreated hyperthyroidism may do more than just look like early menopause — it may actually trigger it, report experts at Johns Hopkins. The good news is, treating your thyroid may ease symptoms of early menopause and may even prevent menopause from kicking in too early.
Symptoms hyperthyroidism and perimenopause share:
Fatigue and muscle weakness
Heat intolerance/hot flashes
Increased sweating/night sweats
Sleep disturbances, difficulty sleeping or insomnia
Palpitations (noticeable, rapid or irregular heartbeats)
Weight changes (loss more typical, but sometimes weight gain)
Hair loss or thinning hair
Anxiety, irritability, mood swings
Irregular or lighter menstrual periods
Frequent urination
Beyond the shared symptoms, there's another reason early detection and treatment of hyperthyroidism is so essential: The risk of heart disease and bone loss accelerates around the time of menopause — and hyperthyroidism can further amplify those risks, according to a 2023 report from Germany.
Hypothyroidism: When your thyroid slows down
Hypothyroidism, or underactive thyroid, is when your thyroid gland doesn't make enough hormones. (A common cause is an autoimmune condition called Hashimoto's disease, which is more common in women and often strikes between the ages of 30 and 50.)
Symptoms hypothyroidism and perimenopause share:
Fatigue, tiredness, lack of energy
Weight gain or increased body fat
Sleep disturbances, difficulty sleeping, insomnia
Depression, low mood or mood swings
Loss of sex drive
Problems with memory, focus or brain fog
Hair loss or thinning
Muscle/joint aches, pain, weakness or cramps
Irregular, heavier or changed menstrual periods
Dry skin (sometimes dry hair, brittle nails)
Constipation
Fluid retention, puffiness
How to diagnose thyroid problems vs. menopause
To put it simply, women's bodies are complicated, says Dr. Anne Rentoumis Cappola, professor of medicine in the division of endocrinology, diabetes and metabolism at the University of Pennsylvania Perelman School of Medicine. And what happens around the time of menopause is even more complicated. That's why Cappola recommends starting with your primary care provider or gynecologist — not Dr. Google.
After all, there are no short cuts to working with your provider to find the true cause of your symptoms — and finding the right treatment. "Don't fall for quick-fix solutions or extreme diet fads," Isaacs warns. "These rarely help and can sometimes harm. Instead, seek a thorough, evidence-based evaluation."
Here's how to approach your appointment strategically:
Go in person: While online menopause clinics can be helpful for many things, if you suspect a thyroid issue, choose the office instead. "Because these symptoms are so common, sometimes we also must look for entirely different causes: Heart, neurological, infectious or mental health conditions, among others," says Isaacs. Plus, many midlife symptoms compound each other. "There could be a plethora of things happening together, feeding off of each other," says Dr. Ekta Kapoor, an associate professor of medicine at the Mayo Clinic College of Medicine in Rochester, Minn. "Your doctor needs to see the full picture to untangle what's really going on."
Come prepared, not predetermined: "While you're an expert in your symptoms, remember that not everyone presents in a classic way," says Cappola. So, even if you have all the symptoms associated with a thyroid problem, it doesn't necessarily mean your thyroid is the issue. "We don't make diagnosis based on symptom lists," Cappola says, who advises leading your appointment with your worries — not your home-spun diagnosis.
What your doctor needs to know: The more specific information you can provide about your symptoms, the better your doctor can help narrow down the cause. Details like how long ago symptoms started, what makes them better or worse, how long they last, and which symptom bothers you most can all provide important clues. "Share information describing how you feel, which helps us ask the next questions to try to find the root cause," says Cappola. To help get yourself organized — and get your doctor a clear picture — keep a symptom diary for at least two weeks before your appointment. You can go the good old pen-and-paper route, or try a tracker like the hospital-approved Bearable app.
At-home thyroid tests: Are they accurate?Spoiler alert: Social media influencers and TikTokers who tout at-home tests and fast fixes aren't an authority on your health. "When there's an information void — like with thyroid issues in middle age — there's an opportunity for people to fill it," says Cappola, noting that it's rarely the right people filling that void. These sources often oversimplify midlife issues, especially if they've been under-addressed in the past.
The reality is that home test kits may not be reliable. Not only can test accuracy vary depending on how you collect your sample, but these kits haven't been validated in large studies, note experts at the Columbia Thyroid Center. These kits tend to offer you information that you won't know how to interpret — home kits often offer broad panel testing, which can be more misleading than helpful without clinical context.
Plus, taking a home test won't save you time or money in the long run. "Even if the test comes back mildly abnormal, you're still going to need confirmatory testing in the lab. And if it comes back normal but you still have symptoms, you'll likely need another test," says Kapoor. And worse, a false negative could delay needed care, while a false positive could lead to unnecessary worry or treatment.
That said, Columbia experts note that, as a screener, home testing may be helpful for those who haven't been able to see a doctor and are looking for a quick and convenient way to obtain a test result to guide a referral to appropriate health care providers. (One well-rated brand to consider: the Thyroid Antibody Test from LetsGetChecked.)
In short: "If you think you have a thyroid condition, it's better to have the right type of testing in a trusted laboratory," says Kapoor. Home kits might scratch the itch for quick answers, but real answers and guidance come from a clinician who knows your full history.
Thyroid blood tests: TSH, T3 and T4 explained
Your doctor will likely order blood tests to check your thyroid function, typically starting with TSH (thyroid-stimulating hormone). Depending on results, they may also test T3 and T4 (the actual thyroid hormones) and, sometimes, thyroid antibodies. Understanding these basic terms can help you have more informed conversations with your health care team.
Thyroid and menopause treatment options
"When it comes to thyroid treatment, the good news is we have effective, well-tolerated therapies," says Isaacs. For hypothyroidism, daily levothyroxine usually restores normal hormone levels and relieves symptoms. Hyperthyroidism is treated with medications, sometimes surgery or, in rare cases, radioactive iodine therapy.
There are also a variety of solutions that can help with menopause, from hormone therapy to lifestyle interventions. However, "if both thyroid dysfunction and perimenopause are going on at the same time, treating the hypothyroid piece may not make you feel completely better if you still have [hot flashes] and other perimenopausal symptoms," says Dr. Elizabeth Pearce, professor of endocrinology, diabetes, nutrition and weight management at the Boston University Chobanian & Avedisian School of Medicine.
This means you may need a comprehensive treatment approach that addresses both conditions — and patience as your medical team works to untangle what's causing what.
Can you combine hormone replacement therapy with thyroid medication?
Short answer: Yes — but with some important caveats.
Hormone therapy, also known as menopausal hormone therapy (MHT) or HRT, is the gold standard for treating a host of menopause symptoms. (We're looking at you, hot flashes and sleepless nights!) But MHT can interact with thyroid hormones in subtle but important ways, particularly for people with hypothyroidism who take daily thyroid medication, like levothyroxine.
That's because oral estrogen increases the level of a thyroxine-binding globulin (TBG), a protein that binds up thyroid hormone in the blood. So you may need a higher dose of thyroid medication to keep your levels in the optimal range, according to a 2024 report in the journal Maturitas.
While this isn't a reason to avoid hormone therapy for menopause — it is a reason to keep your doctor in the loop. A simple blood test can help determine if your thyroid dose needs adjusting.
PS: Transdermal estrogen, like patches or gels, doesn't raise TBG levels and typically doesn't affect thyroid function — which is why many clinicians prefer it for people managing both menopause and thyroid issues.
Thyroid supplements: What works and what's risky
"I specifically caution patients to avoid supplements marketed for thyroid," says Pearce. Besides the risk of being unsafe, using them could skew blood test results, she explains. An older study in the journal Thyroid found that the majority of the supplements for thyroid support contained significant amounts of thyroid hormones, enough to cause elevated thyroid hormones in the blood and symptoms of hyperthyroidism as well as arrhythmias and bone loss — a worry that lingers.
Even seemingly harmless supplements can interfere with testing. The American Thyroid Association reports that taking a high dose of biotin (often used for thinning hair in menopause) can change thyroid test results and lead to an incorrect diagnosis.
"The only supplement for which there is a little bit of evidence is selenium," says Pearce. "But in the U.S., it's pretty hard to be selenium deficient." That said, if you have hyperthyroidism or thyroid eye disease, some health care providers may recommend selenium, which is an essential mineral that supports a healthy thyroid gland, according to Cleveland Clinic. (One to ask about: Thorne Selenium, which is third-party tested for purity and potency.)
Menopause or thyroid: Getting the right diagnosis
It's important to seek care for yourself and treat bothersome symptoms, no matter what the cause. A good doctor can likely get you to a resolution faster than no doctor at all. Getting answers about midlife symptoms requires patience and the right medical partnership. While the overlapping symptoms of thyroid dysfunction and menopause can be frustrating to sort through, working with health care providers who understand both conditions — and take your concerns seriously — is the key to feeling like yourself again.
Meet our experts
Scott Isaacs, MD, a board-certified endocrinologist and obesity specialist at Emory University School of Medicine in Atlanta and president of the American Association of Clinical Endocrinology
Ekta Kapoor, MBBS, endocrinologist who specializes in women's health and associate professor of medicine at the Mayo Clinic College of Medicine in Rochester, Minn.
Elizabeth Pearce, MD, professor of endocrinology, diabetes, nutrition and weight management at Boston University Chobanian & Avedisian School of Medicine
Anne Rentoumis Cappola, MD, professor of endocrinology, diabetes and metabolism at the University of Pennsylvania Perelman School of Medicine
Our health content is for informational purposes only and is not intended as professional medical advice. Consult a medical professional on questions about your health.