If you’re having hot flashes in your late 40s, you might assume there’s just one explanation: menopause. But for a small number of people, thyroid issues turn out to be responsible. An overactive or underactive thyroid gland can cause hot flashes, depression, insomnia, and many other classic menopause symptoms. In this piece, we’ll explore the overlap between thyroid issues and menopause, and learn how doctors tell the difference.

What Are Hypothyroidism & Hyperthyroidism?

Your thyroid is a small, butterfly-shaped gland located at the front of your neck. It’s responsible for creating your thyroid hormones—a group of chemicals that play a major role in your childhood development, metabolic health, and cardiovascular health. When the gland is underactive, it’s known as hypothyroidism, while an overactive gland is called hyperthyroidism.

Generally speaking, hyperthyroidism causes a ‘speeding up’ of your metabolic processes. You might lose weight, feel hyperactive or nervous, develop a rapid heartbeat, feel overheated, get diarrhea, and have difficulty falling asleep, among many other symptoms. Hypothyroidism, conversely, causes a ‘slowing down.’ You might feel lethargic, depressed, tired, cold, and constipated.

Thyroid problems are surprisingly common. It’s estimated that 20 million people in the US (about 6% of the population) have some form of thyroid disorder. More than half of the individuals with thyroid disease are unaware that they have it, leaving them in the dark about the symptoms they’re experiencing. And as we’ll see shortly, some of these symptoms can be easily mistaken for the menopause symptoms of menopause.

What Is Menopause?

Menopause is the end of your reproductive years. You’re born with a certain number of eggs, and when they run out, you can no longer get pregnant. Your body stops ovulating and menstruating, meaning you stop having monthly periods. This coincides with a major drop in estrogen.

Estrogen is an incredibly important sex hormone. Almost every tissue and organ in your body responds to it in some way. That’s why falling estrogen levels cause such dramatic changes to your mind and body during the menopausal transition. Most of these symptoms appear during perimenopause—the transitional phase between your reproductive years and menopause. 

Thyroid Disorders & Menopause: Where the Symptoms Overlap

Hot Flashes & Night Sweats

Hot flashes (sometimes called hot flushes) are one of the most common menopause symptoms, affecting around 80% of menopausal women. We don’t entirely understand their underlying causes, but hot flashes seem to be triggered by changes in the brain due to falling estrogen levels. Specifically, these changes seem to affect the hypothalamus—a part of the brain sometimes called “the body’s thermostat” thanks to its role in regulating temperature.

Hyperthyroidism can cause symptoms similar to hot flashes, such as excess sweating, high body temperature, and heat intolerance. For both people in the menopause transition and people with thyroid disorders, hot flashes can lead to overheating and sweating while you sleep. These awakenings (called night sweats) can severely compromise the quality of your sleep, leading to sweat-soaked sheets and restless nights.

Insomnia

Roughly 60% of people experience insomnia (difficulty sleeping) during menopause. This is for several reasons. First, as we described above, night sweats interrupt sleep. Second, menopause changes brain chemistry in ways that may make high-quality sleep more elusive. 

Hyperthyroidism can cause insomnia in similar ways. It stimulates your nervous system, flooding you with nervous, restless energy that makes sleep difficult. Hypothyroidism may cause insomnia, but the research is less clear. Some authors have speculated that insomnia is simply a consequence of cold sensitivity, joint pain, and other direct symptoms of hypothyroidism.

Fatigue

Menopause causes fatigue in several ways. First, fluctuating hormones can directly affect your mood, making you feel down, sluggish, and possibly depressed. Second, night sweats interrupt your sleep, leaving you drained during the daytime. 

This is very similar to the fatigue caused by hyperthyroidism: Nervous energy causes insomnia, leaving you fatigued. Hypothyroidism, on the other hand, can also cause fatigue—but more directly. By slowing down your metabolism, it simply drains your energy levels and leaves you sluggish.

Weight Gain

While many people think that menopause causes weight gain, the reality is more complex. People do tend to gain weight as they age, but the bigger impact of menopause is on fat distribution in your body. During your reproductive years, high estrogen levels trigger fat storage at your hips and breasts. When estrogen falls, fat is redistributed to your midsection. This fat (which is called abdominal or visceral fat) can change your shape, even if it doesn’t change your overall weight.

Hypothyroidism, on the other hand, does cause weight gain by slowing down your metabolism. The American Thyroid Society suggests that gaining 5-10 pounds is typical. (Hyperthyroidism doesn’t typically cause weight gain, and if anything, may cause weight loss.)

Irregular Periods

Irregular menstruation is one of the most common signs that you’re approaching menopause. As your body’s supply of eggs is depleted, the ovulation process becomes more erratic before eventually stopping entirely. 

Both hyperthyroidism and hypothyroidism also cause irregular periods, as well as very light and very heavy bleeding. They may also cause you to miss periods for several months—another phenomenon that is common as menopause approaches. In one study, 23% of women with hypothyroidism experienced irregular periods.

Thyroid Disorder & Menopause: Which Symptoms Don’t Overlap?

If you’re experiencing symptoms that could be either thyroid issues or menopause, it’s important to speak with your doctor right away. Only a professional healthcare provider can properly evaluate you and make an informed diagnosis. 

In the meantime, there are some unique features that can help you distinguish between the two conditions. Here are some signs of thyroid disorder that don’t typically overlap with menopause symptoms:

Unique Hyperthyroidism Symptoms

• Bulging eyes
• Weight loss
• Excessive hunger
• Diarrhea

Unique Hypothyroidism Symptoms

• Slow heart rate
• Constipation

How Thyroid Disorders Are Diagnosed

If you aren’t sure whether you’re dealing with a thyroid disorder or menopause, there’s some good news: Thyroid disorders are very easy to test for. Your doctor will first ask you some questions about your symptoms to determine whether you’re at risk. If so, they will use a simple blood test to measure your levels of T3 and T4—the two major thyroid hormones—as well as thyroid stimulating hormone (TSH). 

If your T3, T4, and TSH levels are in the normal range, there may be another explanation for your symptoms (such as menopause). But if they are “out of range” (i.e. unusually high or low), the doctor may diagnose you with hypothyroidism or hyperthyroidism.

What If I’m in Menopause & Have a Thyroid Disorder?

If you’ve been diagnosed with a thyroid disorder after menopause, it’s important to get it treated right away. Thyroid disorders can worsen the long term health implications of menopause, particularly in two areas:

Bone health: Osteoporosis is a major concern for menopausal people. As estrogen levels fall, bone mass decreases. This leads to thinner, lighter bones that are more fragile. Bone fractures, especially in the spine and hips,  are a serious health concern for aging individuals. Hyperthyroidism also causes bone loss and increases the risk of fractures, as well. These two conditions combined may have an extra damaging effect on your long-term bone health.

Heart health: During menopause, falling estrogen seems to increase the risk of heart disease. Researchers don’t entirely understand this effect, but it’s been well established that estrogen is “cardioprotective.” Thyroid disorders can also damage your heart health. Hyperthyroidism overtaxes your heart, causing it to work harder than it should. Hypothyroidism, on the other hand, can reduce your heart’s capacity to pump blood and increase the risk of heart disease.

Thyroid Disorder & Menopause: How Are They Treated?

Although thyroid disorders and menopause can manifest in similar ways, they’re caused by entirely different underlying issues and require different treatment approaches.

If you are diagnosed with hyperthyroidism, your doctor will choose an appropriate treatment to bring your thyroid activity down to a normal level. And if you have hypothyroidism, you’ll likely need to take levothyroxine—a synthetic equivalent of your natural thyroid hormones. 

On the other hand, if it turns out you’re experiencing symptoms of menopause, you’ll have a number of treatments available. The type of treatment your doctor recommends will probably depend on which symptoms are impacting you most. Here are some options you may consider:

• Menopausal hormone therapy (MHT): MHT uses estrogen and progesterone to support your falling hormone levels. This is the gold standard treatment for the most common symptoms of menopause, such as hot flashes, night sweats, insomnia, mood changes, and vaginal dryness.
• Non-hormonal therapy: SSRI or SNRI medications (which were originally developed to treat depression) have also been proven effective in treating the vasomotor symptoms of menopause (eg, hot flashes and night sweats).
• Over-the-counter treatments: Some non-prescription supplements (including black cohosh and swedish flower pollen) may be helpful in addressing hot flashes and night sweats. And for symptoms like vaginal dryness and painful intercourse, vaginal moisturizers and lubricants can be helpful. Note that these are not FDA-approved menopause treatments, so it’s very important to discuss with your doctor before embarking on any changes. 

The Bottom Line

Menopause and thyroid disorders can cause a number of overlapping symptoms, as well as some unique ones. Talk with your doctor about what you’re experiencing. If there’s a chance you have a thyroid disorder, it can be diagnosed with a simple blood test and treated with specific medication. And if it turns out you’re dealing with menopause symptoms, you can discuss the treatment options with your doctor. There are safe and effective medications available that can ease your symptoms today.