How to Differentiate Between Thyroid Issues and Menopause?

  • 1st Revision: Emma Soopramanien
  • 2nd Revision: Manisha Kuttetira
  • 3rd Revision: Shikha Javaharlal

Introduction

Feeling irritated, gaining weight and/or having sleep problems? 

Many women in their forties and fifties assume menopause is to blame. However, do not leap to conclusions. These symptoms might indicate an overactive or underactive thyroid gland. Other symptoms shared by menopause and thyroid issues, such as tiredness, depression, hair loss, and hot flashes, make it difficult to distinguish between the two. 

Are the additional pounds the result of ageing or hypothyroidism? Is it perimenopause that's causing the mood swings and exhaustion, or is it something else? Knowing what is wrong is the key to dealing with both diseases.

What is Hypothyroidism and Hyperthyroidism?

The thyroid gland is a butterfly-shaped gland on the front of the neck generating hormones that aid in the regulation of the body's metabolism and normal functioning of the brain, heart, muscles, and others. However, sometimes it may do too much or too little. 

Hyperthyroidism is caused by an overactive thyroid, and may lead to nervousness, irritability, and shakiness. Symptoms include: 

  • a racing heart 
  • increased perspiration 
  • heat sensitivity 
  • frequent bowel movements 
  • receding hair 
  • weight loss
  • irregular periods 

On the other hand, hypothyroidism is due to an underactive thyroid gland and may cause the body to slow down. Symptoms include:

  • slowed thinking 
  • sadness 
  • feeling chilly 
  • constipation 
  • muscular weakness 
  • irregular periods 
  • a slower metabolism leading to mild weight gain 
  • memory loss
  • loss of hair at the ends of your brows - a rare symptom  

One in every twenty people in the UK have thyroid disease, but this figure might be higher since many people are unaware they have a problem.1 Also, since many of the signals are so prevalent, it is easy to overlook them.

Symptoms of Menopause

Menopause is a biological process identified after 12 months of not having a menstrual cycle. It is the moment when your menstrual cycles come to an end. However, the physical and mental symptoms of menopause, e.g. hot flashes, may interrupt sleep, diminish energy, and damage emotional health.2 There are several effective therapies available, from lifestyle changes to hormone medication. 

Patients may encounter signs and symptoms of vaginal dryness months or years before menopause (perimenopause), namely irregular periods, hot flushes, chills, and night sweats. Other symptoms include sleep issues, mood changes, weight gain, reduced metabolism, dry skin, hair, and loss of breast fullness. Signs and symptoms, like changes in menstruation, might differ across women. Period skipping is typical and anticipated during perimenopause. Menstrual cycles often miss a month and then return or skip many months and restart later. Periods also tend to occur in shorter cycles, bringing them closer together.2 

Oestrogen Levels and Thyroid Function

In reality, millions of women experiencing menopausal symptoms, including those on oestrogen treatment, may be suffering from undetected hypothyroidism.3 A 2011 study suggested that oestrogen directly affects human thyroid cells.4 Typically, when a woman approaches menopause, her ovarian reserve declines, resulting in decreased oestrogen production in the ovaries. 

Oestrogen levels have been shown to have indirect and direct impacts on thyroid function. Oestrogen is a very active hormone.3 Excess or inadequate amounts can have serious consequences. Your body demands the exact quantity, and any variation might impact the delicate link between oestrogen and thyroid function. Too much oestrogen can negatively impact thyroid function as high oestrogen levels in the bloodstream signal the liver, boosting thyroid-binding globulin (TBG) synthesis.3 This is an inhibitor protein: TBG binds to thyroid hormone and reduces the quantity of the two main thyroid hormones, T3 and T4, accessible to cells. To compensate for the deficiency, the thyroid gland increases output. 

Distinguishing between Hypothyroidism and Menopause

According to the American Association of Clinical Endocrinologists (AACE), millions of women experiencing menopausal-like symptoms, including those taking oestrogen, may have undiagnosed thyroid disease. Only one in four women who discussed menopause and its symptoms with a doctor were also tested for thyroid disease.5

Distinguishing between hypothyroidism and menopause can be difficult as a patient approaches menopause.  While fatigue, sleep disruption, depression, mood swings, forgetfulness, irritability, gaining weight, hair loss and dry skin are commonly associated with menopause, they may also be signs of hypothyroidism. Check body heat to distinguish between the two, as hot flashes and night sweats are unique to menopause. There is one exception, according to Kapoor, an endocrinologist at the Mayo Clinic: "Over-replacement with thyroid hormone can also cause hot flashes and night sweats."6 

The thyroid gland regulates body metabolism and impacts the heart, brain, kidneys, reproductive system, muscle strength and appetite. As previously mentioned, hypothyroidism symptoms can be attributed to menopause. While menopause must be addressed, it is also important to remember that the prevalence of hypothyroidism increases with age and can co-occur with other conditions.7 

How thyroid problems can affect menopausal symptoms

Thyroid problems might raise the risk of difficulties connected with menopause. People assigned female at birth (AFAB) are more prone to develop osteoporosis. An overactive thyroid might also increase the chances of developing the illness. Similarly, the risk of cardiovascular disease rises with menopause; thyroid disorders also enhance the risk. Thyroid issues may raise the probability of difficulties occurring during menopause. As with an underactive hyperthyroid, it can cause symptoms comparable to menopause, such as hot flashes or heat intolerance.8 

Thyroid Function Tests

The thyroid-stimulating hormone (TSH) test is an excellent blood test for determining early-stage thyroid disease.3 

A high TSH level indicates that your thyroid is underactive and that you may suffer from hypothyroidism. A low TSH level, on the other hand, usually suggests the thyroid is hyperactive and produces too much thyroid hormone (T3/T4). If something prevents the pituitary gland from activating the thyroid gland, such as a tumour or inflammation, the test will also yield a low TSH value, diagnosed as secondary hypothyroidism. 

If TSH test results are abnormal, further thyroid tests determine thyroid imbalance causes:3 

  • T4-tests: The thyroid gland generates 94% T4 and just 6% T3. During circulation, unique proteins in the blood attach to T4 and T3. A “Total T4” blood test measures the total amount of free and bound T4. It is not the most reliable blood test for determining thyroid function. Doctors may also request a free T4 index (FTI) or free T4 (FT4) test. The latter is the most useful.
  • T3-tests: When detecting an overactive thyroid, a T3-test is more reliable. It may not help someone suffering from hypothyroidism and menopausal symptoms. 
  • Thyroid Antibody Screening: The immune system in a healthy body sends antibodies into the circulatory system to aid in the battle against foreign invaders. However, the immune systems of many patients with thyroid issues “see” the thyroid gland as a foreign intruder, resulting in antibody production against the thyroid cell proteins. Thyroid antibody tests detect and quantify the presence of two key antibodies produced against thyroid cell proteins (thyroglobulin antibody and thyroid peroxidase antibody). If experiencing overlapping symptoms of hypothyroidism and menopause, these antibody tests, in conjunction with others like T3 and T4, may establish a definitive diagnosis.
  • Radioactive Iodine Uptake (RAIU) Test: A very low RAIU is occasionally used to rule out hypothyroidism, whilst a high RAIU might help to diagnose an overactive thyroid. However, this is an old-fashioned test. 

Treatment for thyroid problems and menopause symptoms

Prescription thyroid hormone supplements are often used to treat hypothyroidism.9 Conversely, medication, surgery, or radiation may be required to treat hyperthyroidism. When undergoing treatment for thyroid disease, doctors will check thyroid hormone levels to see how well the medication works. 

Regardless of thyroid condition, oestrogen replacement medication may be beneficial in alleviating the symptoms of perimenopause/menopause. Some women utilise oestrogen supplementation throughout the symptomatic period of perimenopause and menopause and can cease medication, whilst others need long-term treatment. 

If experiencing side effects like hypertension, vaginal dryness, urinary infections, sleeplessness, mood problems, or osteoporosis, therapy for these symptoms (supplementing thyroid medication/oestrogen hormone replacement) may be needed. For example, people AFAB suffering from depression may benefit from antidepressants. In addition, osteoporosis may be treated with prescription medications, such as Fosomax (alendronate), to prevent bone disintegration.9

However, Rosenfeld advises against using synthetic thyroid hormone therapy to treat menopausal symptoms in people AFAB who have normal thyroid function.5 While there is a lot of overlap in the symptoms, if the thyroid blood tests are normal, it would be wrong to treat a person without thyroid disease with thyroid hormone or increase thyroid hormone in a person with hypothyroidism to alleviate menopausal symptoms. 

When to see a Doctor

The more information patients have about their condition, the better.3 If you suspect any hypothyroidism and/or menopause symptoms, make an appointment with a doctor. Do not assume they are the result of menopause/perimenopause. Consider informing the physician if there is a family history of thyroid issues. Telling a specialist about any symptoms you experience could help resolve them. 

Summary

The prognosis for someone with an underactive thyroid is favourable with medication and thyroid hormone control. This is a common ailment that is easily managed with medicine. Menopausal symptoms may be uncomfortable for many years, but it is a normal transition, and most people have no problems after it is complete. 

The association between an underactive thyroid and menopause is complex, with several variables at play. The symptoms of each of these disorders may be quite similar, and they can occasionally combine in ways that make them worse. It is critical to contact a doctor who will listen and provide the help required to get an accurate diagnosis and a successful treatment plan.

References:

  1. Thyroid Statistics UK 2019 - Thyroid Issues In The UK. Forth [Internet]. 2020 [cited 2022 Mar 18]. Available from: https://www.forthwithlife.co.uk/blog/thyroid-statistics-uk-how-many-suffer-from-under-active-or-overactive-thyroid-problems/.
  2. Menopause - Symptoms and causes. Mayo Clinic [Internet]. [cited 2022 Mar 18]. Available from: https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397.
  3. Hypothyroidism, Estrogen & Menopause: What’s the Link? | imaware™ [Internet]. [cited 2022 Mar 18]. Available from: https://www.imaware.health/blog/hypothyroidism-and-menopause.
  4. Santin A, Furlanetto T. Role of Estrogen in Thyroid Function and Growth Regulation. Journal of Thyroid Research. 2011;2011:1-7.
  5. Thyroid Disease and Menopause Information on MedicineNet.com. MedicineNet [Internet]. [cited 2022 Mar 18]. Available from: https://www.medicinenet.com/thyroid_disease_and_menopause/views.htm.
  6. What to Know About Menopause if You Have Hypothyroidism. EverydayHealth.com [Internet]. [cited 2022 Mar 18]. Available from: https://www.everydayhealth.com/hypothyroidism/what-to-know-about-menopause/.
  7. Thyroid Disease and Menopause. WebMD [Internet]. [cited 2022 Mar 18]. Available from: https://www.webmd.com/menopause/guide/symptoms-thyroid-vs-menopause.
  8. Thyroid and menopause: Explaining the link [Internet]. 2018 [cited 2022 Mar 18]. Available from: https://www.medicalnewstoday.com/articles/320130.
  9. What’s the Link Between Thyroid Disease and Menopause? Verywell Health [Internet]. [cited 2022 Mar 18]. Available from: https://www.verywellhealth.com/thyroid-disease-menopause-link-3231797.

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Sara Maria Majernikova

Bachelor of Science - BSc, Biomedical Sciences: Drug Mechanisms, UCL (University College London)
Experienced as a Research Intern at Department of Health Psychology and Methodology Research, Faculty of Medicine, Laboratory Intern at Department of Medical Biology, Faculty Medicine Biomedical Sciences Research Intern and Pharmacology Research Intern.

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