Menopause and Hypothyroidism

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Menopause is a permanent cessation of the menstrual flow caused as a result of the irreversible loss of the ovarian follicles due to inactivity caused by aging. This stage is preceded by a long period of transition in the female life cycle, and it signifies a move from the reproductive stage to the post-reproductive stage.

The transitional period may be accompanied by symptoms like headaches, hot flashes, general weakness, sleep irregularity, palpitations, night sweats, anxiety, mood swings also known as climacteric symptoms, and an irregular menstrual cycle. 

Although for some women, “these climacteric or menopausal symptoms are usually worse during the early stage known as perimenopause but usually cease within a year or so after the last period known as the postmenopause”. However, it is best to ascertain the cause of the symptoms through a medical test, as there are other illnesses like thyroid disease- hypothyroidism that exhibit similar symptoms. 

Thyroid diseases can affect both males and females but the incidences are much higher in females (5%-10%) than in males. Thyroid problems like hypothyroidism are more prevalent during perimenopause and postmenopause years; studies have shown that in a natural menopausal transition, progesterone levels gradually decline, while estrogen levels either remain within the normal range or it may increase leading to estrogen dominance as opposed to the phenomenon behind the menstrual cycle where both the progesterone and estrogen “counterbalances” each other. 

However, excess estrogen production inhibits the action of the thyroid gland. Hence, even when the thyroid gland is producing normal hormones (because they are not malfunctioning), they are rendered ineffective and this situation results in the appearance of hypothyroidism symptoms. Hypothyroidism can be overt or subclinical; for overt hypothyroidism, both the Thyroid Stimulating Hormone (TSH) level and the thyroid hormone level are abnormal while in subclinical hypothyroidism, the Thyroid Stimulating Hormone level is abnormal while the thyroid hormone level is normal.

Symptoms of hypothyroidism manifest as; 

  • dry skin (or even drier skin for subclinical) 
  • Weight gain (for subclinical)
  • poor memory,
  • slower thinking, 
  • somnolence, tiredness, 
  • muscle cramps, 
  • feeling cold, 
  • hoarse voice, 
  • general oedema, and
  • constipation

FAQs about Menopause and Hypothyroidism

Is Hypothyroidism more common after menopause?

Yes, most thyroid diseases like Hypothyroidism are prevalent in postmenopausal and elderly women because high levels of thyroid-stimulating hormone increase with age. But, caution should be applied in categorizing “after menopause” as some women attain menopause prematurely due to ovarian insufficiency. 

Can menopause affect levothyroxine?

No, because levothyroxine is a medicine that is used for the treatment of thyroid hormone deficiency. 

Can thyroid levels change after menopause?

The level of thyroid stimulating hormone remains normal but with a tendency to higher limits due to age.

How do I know if it is menopause or thyroid?

Often, premenopausal symptoms may be the same as that of thyroid disease, the best way to be sure is to go for a medical test. There are several ways through which menopause can be confirmed but, it is advised that “if you decide to seek medical confirmation regarding menopause, it is important that you understand what tests are available, what they can (and cannot) reveal about your current status.”

What are the symptoms of thyroid problems in older females?

 For older females, the symptoms include;


-Weight gain


-Horse voice



-Mild confusion 



What is the normal TSH level for a postmenopausal woman?

Although there is still controversy about the actual normal TSH level, it is recommended that the TSH levels should be 4.03 and 5.9 mIU/l in those who are 50-59 and 70-79 years old (for those without, thyroid diseases, anti-thyroid antibodies, and medications influencing thyroid function). 

How can you tell the difference between perimenopause and hypothyroidism?

Since perimenopause and hypothyroidism have similar symptoms, the best way to know the difference is through a laboratory test to know the thyroid stimulating hormone (TSH). An abnormal TSH level may be an indication of thyroid problems.

Do you get hot flashes with underactive thyroid?

No, hot flashes are one of the symptoms associated with the overproduction of thyroid hormone also known as hyperthyroidism-

Do you get thyroid problems during menopause?

“The fact that about 26% of women in or near perimenopause are diagnosed with hypothyroidism is a sign that there is a cause-and-effect relationship between hypothyroidism, in which there are inadequate levels of thyroid hormone and estrogen dominance”.

Author: Jessica Damian

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References :

+ Christiane Northrup, 2021. The Wisdom of Menopause, (4th Edition): Creating Physical and Emotional Health During the Change. Hay House, Inc.

+ Slopien, R., Owecki, M., Slopien, A., Bala, G., & Meczekalski, B. (2020). Climacteric symptoms are related to thyroid status in euthyroid menopausal women. Journal of endocrinological investigation, 43(1), 75-80.

+ Zubyra, S. J., Hossain, M. S., Hossain, M. Z., Barman, T. K., Islam, M. T., & Fattah, S. A. (2022). Association Between Serum Vitamin D And TSH Status Levels And Thyroid Stimulating Hormone (TSH) In Postmenopausal Women. Sch Int J Obstet Gynec, 5(8), 378-382.

+ Nanette Santoro, Cassandra Roeca, Brandilyn A Peters, Genevieve Neal-Perry, The Menopause Transition: Signs, Symptoms, and Management Options, The Journal of Clinical Endocrinology & Metabolism, Volume 106, Issue 1, January 2021, Pages 1–15,

+ Gietka-Czernel M. (2017). The thyroid gland in postmenopausal women: physiology and diseases. Przeglad menopauzalny = Menopause review, 16(2), 33–37.

+ del Ghianda, S., Tonacchera, M., and Vitti, P. (2014). Thyroid and menopause. Climacteric 17 (3), 225– 34.


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