Is It Thyroid or Perimenopause? Let’s Find Out

Is it the thyroid causing all the health chaos in your life, or is perimenopause quietly making its entrance? Both can leave you feeling tired, moody, and a little out of sorts, but figuring out which one is behind your symptoms can feel like solving a tricky puzzle. Thyroid disorders, particularly hypothyroidism, are common among Indian women. Studies reveal that around 13%-15% of middle-aged Indian women are affected by subclinical hypothyroidism. Symptoms of thyroid that overlap with perimenopause often make it even harder to pinpoint the cause.

Keep reading to understand and differentiate whether it is thyroid or perimenopause, and learn how to recognise the signs of each so you can better understand what your body is trying to tell you and take the right steps towards feeling like yourself again.

Perimenopause vs thyroid problems: Why the confusion?

Perimenopause is a natural transitional phase leading up to menopause, during which levels of oestrogen and progesterone fluctuate unpredictably. It can begin as early as the mid-30s and may continue for several years. During this time, many women experience fatigue, mood swings, brain fog, weight changes, and irregular periods.

Interestingly, these are also classic symptoms of thyroid disorders, particularly hypothyroidism, and in some cases, hyperthyroidism. Both conditions can mirror the effects of perimenopause, with signs such as low energy, dry skin, thinning hair, difficulty concentrating, and low mood appearing in either case.

This overlap often leads to confusion, with many women mistaking hyperthyroidism or hypothyroidism for perimenopause, or attributing perimenopausal symptoms to thyroid issues. Since both conditions are common in midlife, distinguishing between them can be challenging without proper evaluation.

How perimenopause affects the thyroid (and vice versa)

Wondering, does perimenopause affect the thyroid? Yes, it does; perimenopause and thyroid function are interconnected. The thyroid, a butterfly-shaped gland in the neck, produces hormones that control energy and metabolism

Thyroid plays a very important role in assisting us to metabolize the food we eat, convert it to energy to carry out body functions, manage our weight, temperature control, it is even linked to how we think, talk and sleep. Hence, a disturbance in its function affects all bodily functions resulting in fatigue, poor concentration, cold intolerance, excessive weight gain, dry skin, hair loss, constipation, general sluggish activity. Thyroid hormone levels and function are under the effect of progesterone and estrogen. 

Decreasing oestrogen levels during perimenopause can interfere with the body's availability and utilisation of thyroid hormones. Thyroid abnormalities and inflammation can also be triggered by low progesterone levels, which are common in women experiencing perimenopause. 

On the other hand, hormonal symptoms may worsen due to thyroid dysfunction. For instance, a slow thyroid might impact the metabolism of oestrogen, exacerbating symptoms like mood swings, breast discomfort, and bloating.

Also sometimes underlying thyroid dysfunction gets uncovered  or existing hypothyroidism gets exaggerated, when women start HRT to alleviate perimenopausal symptoms 

Can menopause or perimenopause cause an underactive thyroid?

The overlapping symptoms of thyroid disorders and perimenopause can leave many women wondering: Can menopause cause an underactive thyroid? While menopause and perimenopause themselves don’t directly cause thyroid disease, the hormonal fluctuations during this stage of life can reveal or exacerbate an existing thyroid condition, particularly hypothyroidism. Oestrogen and progesterone levels shift significantly during perimenopause, which may influence how the thyroid functions and how the body responds to its hormones. Since symptoms like fatigue, low mood, weight gain, and brain fog are common to both, it’s easy to confuse the two. This makes proper testing essential to determine whether the root cause is hormonal transition, thyroid dysfunction, or a combination of both.

Key differences between perimenopause and thyroid symptoms

While symptoms can be similar, there are important differences between perimenopause and hypothyroidism to be aware of:

• Menstrual changes are a hallmark of perimenopause, including irregular periods, skipped cycles, or heavier/lighter bleeding patterns.

• Hot flushes and night sweats are typical in perimenopause, often coming on suddenly and disrupting sleep.

• Breast tenderness and emotional fluctuations (such as mood swings or irritability) are more often linked to hormonal shifts in perimenopause.

• In contrast, persistent fatigue, even after rest, is more common in hypothyroidism.

• Sensitivity to cold, unexplained weight gain, and constipation point more strongly towards thyroid dysfunction.

• Hair thinning, particularly around the outer edges of the eyebrows, is more characteristic of hypothyroidism and is often accompanied by diffuse scalp hair loss. In contrast, menopausal hair thinning tends to be more generalised across the scalp. Women experiencing both conditions may notice more pronounced hair loss.

• Mental and physical slowing tends to occur in hypothyroidism, rather than in perimenopause alone.

• Mood changes in perimenopause are often sudden and intense, while depression and anxiety in hypothyroidism are more chronic and come with a sense of heaviness or brain fog.

• In hypothyroidism, fatigue is usually constant and does not improve much with rest. In perimenopause, however, fatigue is often linked to disrupted sleep from night sweats and hormonal fluctuations, making it more variable.

When to get tested?

If you’re feeling off but aren’t sure whether it's thyroid or perimenopause, or both, it’s time to get checked. Don’t dismiss symptoms as “just getting older” or “something all women go through.”

Here’s when to see your doctor:

• You have ongoing fatigue despite adequate rest

• You’ve gained weight without changes to diet or exercise

• You’re having trouble sleeping, despite feeling exhausted

• You’re experiencing irregular heartbeats or palpitations

• You notice changes in your bleeding patterns

• You’ve developed unexpected anxiety or panic episodes

• You’re struggling to concentrate or remember simple things

Quick Explainer

Hair thinning, especially around the outer edges of the eyebrows, is more characteristic of hypothyroidism.

Learning how to differentiate between perimenopause and thyroid

Understanding the overlap between symptoms can be confusing, but taking the time to listen to your body and seek proper medical guidance can make all the difference. If you’ve been wondering, does perimenopause affect the thyroid, know that hormonal changes during this phase can indeed influence thyroid function. A clear diagnosis and the right support can help you manage both more effectively and get back to feeling your best. 

Frequently Asked Questions

1. What are the typical signs of a thyroid disorder?

Thyroid issues can cause fatigue, weight changes, hair thinning, and sensitivity to cold or heat.

2. Why do the symptoms of thyroid problems and perimenopause overlap?

Both involve hormonal imbalances, which can affect mood, energy levels, and metabolism.

3. Can I have both thyroid problems and be perimenopausal at the same time?

Absolutely, it’s quite common, especially in women over 40, and symptoms may overlap or intensify.