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Navigating the various hormonal stages of life can feel like a rollercoaster ride. Perimenopause, menopause, and hypothyroidism are three conditions that can significantly impact a woman’s well-being, but there’s a catch. They often share similar – or even identical – symptoms, making it a challenge to get an accurate diagnosis and effective treatment.

Let’s look at the common symptoms these conditions share, as well as some unique symptoms that can help confirm a diagnosis.

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Before we discuss common symptoms, let’s define perimenopause and menopause.

Perimenopause describes the transitional phase that leads up to menopause. Perimenopause typically starts in your 40s – age 47 is the average –but sometimes as early as the mid- to late-30s. During this time, the ovaries gradually produce less estrogen, leading to irregular menstrual cycles and various physical and emotional changes. Perimenopause can last for several years – 4 years on average -- before menopause officially begins.

Menopause is defined as the end of menstrual periods for 12 consecutive months and marks the end of a woman’s reproductive years. It typically occurs around age 51, although the timing can vary widely among individuals. Once menopause is confirmed, a woman has entered postmenopause, which lasts for the rest of her life.

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Hypothyroidism is a condition that occurs when the thyroid gland fails to produce enough thyroid hormone. The function of thyroid hormone is to regulate metabolism and provide energy for bodily functions.

The most common cause of hypothyroidism in the U.S. is Hashimoto’s thyroiditis, an autoimmune condition that causes an antibody attack that, over time, gradually destroys the thyroid gland. Eventually, most cases of Hashimoto’s cause hypothyroidism. Both Hashimoto’s and hypothyroidism affect women more frequently than men and become more common with age, and often overlap with perimenopause and menopause.

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Menstrual irregularities

During perimenopause, the menstrual cycle becomes irregular, with the length of time between periods varying significantly. Irregular periods can include shorter or longer cycles, heavier or lighter bleeding, or skipped periods altogether. This irregularity is due to the decline in ovarian activity.

In hypothyroidism, research has shown that fluctuations in thyroid hormones can lead to irregular menstrual cycles, heavy periods, or even no periods at all.

Weight gain

During the perimenopausal-menopausal transition, the risk of weight gain increases due to low circulating estrogen levels that result from progressive loss of ovarian function. The changes in hormonal levels, chronological aging, and decline in physical activity – coupled with Western diets and emotional eating – also contribute to the increase in total body weight and higher waist circumference and abdominal weight gain in perimenopausal and menopausal women.

In hypothyroidism, weight gain and difficulty losing weight are common symptoms due to the thyroid’s role in regulating metabolism, including how the body burns fuel for energy. Low thyroid function can also lead to a slower or defective metabolism in muscles, causing body pain, including joint pain, muscle aches or stiffness, muscle weakness, and muscle cramping. Pain that limits exercise and physical activity can contribute to weight gain.

Fatigue

During perimenopause and menopause, women may experience fatigue due to hormonal fluctuations, notably decreasing levels of estrogen and progesterone. These hormonal changes can affect sleep patterns, mood, and energy levels, contributing to feelings of fatigue. Additionally, hot flashes and night sweats can disrupt sleep, which contributes to feelings of fatigue during the day.

In hypothyroidism, the thyroid gland does not produce enough thyroid hormones, leading to a slower metabolism and decreased energy levels. Feeling tired, sluggish, and lacking energy are hallmark symptoms of hypothyroidism. Despite getting enough sleep, people with hypothyroidism may still feel exhausted.

Difficulty sleeping

During perimenopause and menopause, hormonal changes can cause a range of sleep-related problems. Research has shown that the decline in estrogen levels in the bloodstream can lead to insomnia, especially in women who experience hot flashes and night sweats overnight.

In hypothyroidism, difficulty sleeping is a common symptom due to the thyroid’s role in regulating metabolism, including how the body burns fuel for energy. Hypothyroidism is a risk factor for insomnia, sleep apnea, and weight gain, all of which can disrupt sleep. Low thyroid function can lead to a slower or defective metabolism in muscles, causing body pain that disrupts sleep.

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Mood changes, depression, and anxiety

During perimenopause and menopause, many women report mood changes, such as irritability, anxiety, and depression, according to the American College of Obstetricians and Gynecologists (ACOG). The timing of perimenopause and menopause also frequently coincides with a multitude of life stressors like relationship issues, care of young children, struggles with adolescents, return of grown children to the home, being childless, concerns about aging parents and caregiving responsibilities, as well as career and education issues. Getting older in a society that values youth can also lead to changes in self-esteem and body image, contributing to mood changes.

In hypothyroidism, mood changes, depression, and anxiety are common symptoms due to the thyroid’s role in regulating metabolism and the brain’s reliance on thyroid hormone for healthy function.

Dry, itchy skin

In perimenopause and menopause, dry, itchy skin results from decreased estrogen levels in the bloodstream. Estrogen stimulates the body’s production of collagen and oils, which keep the skin naturally moisturized through most of a woman’s life. Once estrogen levels begin to decline, the body’s ability to produce oil slows down, leaving skin dry and itchy.

Hypothyroidism can lead to dry skin due to decreased sweating and a disrupted sweating barrier. The skin’s renewal cycle is broken in hypothyroidism, causing the skin to take longer to grow and accumulating damage. Dead skin may not shed properly, resulting in flaky, dry skin.

Hair thinning and hair loss

During perimenopause and menopause, hormonal changes can cause a range of skin complaints, including thinning hair and hair loss. The decline in estrogen levels can lead to hair thinning and loss, as estrogen stimulates the body’s production of collagen and oils that keep the hair thick and healthy. Hormonal changes can also contribute to female pattern balding starting in perimenopause.

In hypothyroidism, hair loss is often diffuse and involves the entire scalp rather than discrete areas. The hair appears uniformly sparse, and regrowth is usual with successful thyroid treatment, though it may take several months and be incomplete.

Constipation

During perimenopause and menopause, hormonal changes can cause a range of symptoms, including constipation. Estrogen delays gastric emptying and prolongs transit timing, resulting in constipation. This is because estrogen receptors are present in the small intestines and stomach, affecting the muscles’ ability to contract, including the colon. As estrogen levels decrease further, there’s a weakening of the pelvic floor muscles, which can also contribute to constipation.

Thyroid hormones regulate the body’s metabolism, including the function of the digestive tract. When these hormones are deficient, the large intestine does not contract and relax as frequently, leading to reduced gut motility and constipation.

The slowing of the digestive system in hypothyroidism can also result in the overgrowth of bacteria in the small intestine, a condition known as small intestinal bacterial overgrowth (SIBO). SIBO can further contribute to constipation by causing inflammation and altering the normal gut flora.

Decreased libido

Hormonal changes are a significant contributor to low sex drive during perimenopause and menopause. As women approach perimenopause and transition into menopause, declining levels of estrogen, progesterone, DHEA, and testosterone can negatively impact libido and also cause vaginal dryness, which can contribute to a decreased interest in sex for some women.

When thyroid hormone levels are low, many body functions can slow down, including sexual function and desire. This can result in a lack of spontaneous sexual desire, a lack of interest in any sexual activity, and a lack of thoughts or fantasies about sex.

Memory lapses and brain fog

Memory lapses, brain fog, difficulty with words, and forgetfulness are common symptoms experienced by women during perimenopause and menopause. These cognitive issues may be due to declines in estrogen levels, with some studies suggesting that higher levels are associated with better mental performance.

.In hypothyroidism, cognitive dysfunction is a common symptom, often referred to as hypothyroid-associated brain fog. This symptom complex involves cognitive difficulties, including problems with memory and word-finding, and tends to cluster with fatigue and depressed mood.

Muscle/joint aches/pains

Muscle/joint aches/pains are common symptoms experienced by women during perimenopause and menopause. These symptoms appear to be about twice as common closer to the final menstrual period than they are earlier in perimenopause.

.In hypothyroidism, chronic muscle or joint pain is a common symptom, affecting more than half of people with the condition. Hypothyroidism is common in women, especially as we age, and low thyroid function can lead to body pain, including joint pain, muscle aches or stiffness, muscle weakness, and muscle cramping. This is due to the thyroid’s role in regulating metabolism, including how the body burns fuel for energy and can lead to a slower or defective metabolism in muscles.

Heart palpitations

Heart palpitations are a common symptom experienced by women during perimenopause and menopause. The heart’s electrical conduction system is sensitive to changes, including estrogen and progesterone levels, which can lead to misfirings and heart palpitations.

In hypothyroidism, heart palpitations are a common symptom. One way that hypothyroidism can cause heart palpitations is by slowing down the heart rate. When there isn’t enough thyroid hormone, the heart rate can become slower than normal, leading to palpitations. Additionally, hypothyroidism can cause the arteries to become less elastic, which can increase blood pressure and put additional strain on the heart. This can also contribute to heart palpitations.

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While perimenopause, menopause, and hypothyroidism share several common symptoms, some distinctions can help achieve an accurate diagnosis. For instance, there are some unique symptoms typical of perimenopause and menopause that are not usually associated with hypothyroidism. They include:

• Hot flashes and night sweats: Sudden feelings of heat, often accompanied by sweating and flushing, are hallmark symptoms of perimenopause and can continue through into the postmenopausal period. These vasomotor symptoms are not typically associated with hypothyroidism.
• Vaginal dryness and discomfort: Reduced estrogen levels can lead to thinning, dryness, and itching of the vaginal tissues, causing pain during intercourse,  urinary incontinence, and an increased risk of urinary tract infections. These vaginal symptoms are not commonly linked to hypothyroidism.

Conversely, there are some unique symptoms of an underactive thyroid that are not common in perimenopause and menopause. They include:

• Cold sensitivity: Feeling cold more easily than others, particularly in the hands and feet, is a common symptom of hypothyroidism but not typical of perimenopause or menopause.
• Loss of the outer edge of eyebrow hair: Thinning eyebrows, especially from the outer edges, is a characteristic hypothyroidism symptom.

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If you’re experiencing any of these symptoms and don’t know whether they’re related to perimenopause, the transition to menopause, or hypothyroidism, it’s essential to consult with a healthcare professional for proper evaluation and diagnosis. Blood tests to measure hormone levels and thyroid function, along with a thorough medical history and physical examination, can help identify the underlying cause of your symptoms.

Treatment and management strategies for perimenopause, menopause, and hypothyroidism aim to replace missing hormones, alleviate symptoms, and improve overall well-being. Depending on the diagnosis, options may include:

• Hormone replacement therapy (HRT): For perimenopausal and menopausal symptoms, hormone therapy may be recommended to replace estrogen and, in some cases, progesterone.
• Thyroid hormone replacement therapy: Hypothyroidism is typically treated with thyroid hormone medications to restore thyroid hormone levels to normal.
• Lifestyle modifications: Healthy lifestyle habits, including regular exercise, a balanced diet, stress management techniques, and adequate sleep, can help alleviate symptoms and improve overall health.
• Medication: Other medications may be prescribed to manage specific symptoms, such as antidepressants for mood disturbances or medications for managing osteoporosis.
• Regular monitoring: Regular follow-up appointments with your healthcare provider are essential to monitor hormone levels, thyroid function, and overall health and adjust treatment as needed.

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Perimenopause, menopause, and hypothyroidism are three conditions that can significantly impact a woman’s physical and emotional well-being, often sharing similar symptoms that can be confusing to distinguish. By understanding the differences and similarities among these conditions and seeking proper medical evaluation and treatment, women can navigate these life stages more easily and maintain health and vitality for years to come. Remember, if you’re experiencing symptoms that concern you, don’t hesitate to reach out to Paloma Health for guidance.