Low energy, weight gain, irregular periods — could it be perimenopause or thyroid problems?
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Low energy, weight gain, irregular periods — could it be perimenopause or thyroid problems?
One in eight people have a thyroid problem and just about all women go through perimenopause — here's how to tell the difference
By Hazra Khatoon
How can something so small have such a large impact on our bodies?
The thyroid is a 5-centimeter gland in the front of the neck that produces hormones playing a key role in regulating blood pressure, body temperature, metabolism, heart rate, and the reaction of the body to other hormones. In other words, a healthy thyroid allows your body to hum along without thought.
Thyroid disorders, therefore, can negatively affect mood, energy level, bone health, pregnancy, and many other bodily functions. About one in eight people have a thyroid problem, and are more common in women than in men, according to the American Thyroid Association.
What are some of the most common thyroid issues?
Hyperthyroidism is the result of too much thyroid hormone and can lead to Graves’ disease, which has many symptoms, including sweating, arrhythmia (irregular heartbeat), weight loss, and protruding eyes.
Hypothyroidism is the result of the thyroid producing too little thyroid hormone. Symptoms of hypothyroidism can include fatigue, weight gain, depression, and abnormal bone development.
Hashimoto’s Thyroiditis is an inflammation of the thyroid gland and an autoimmune disorder. It can cause swelling in the neck and other annoying symptoms such as fatigue, lethargy, increased sensitivity to cold, dry skin, and constipation.
“Thyroid is controlled by hormones from the pituitary gland in your brain and its main determinant is based on your metabolism. So, it helps regulate your energy metabolism,” says Tara Scott, MD aka “the Hormone Guru,” a Medical Director at Forum Health, and a board-certified OB/GYN with 25 years of experience.
Perimenopause increases the risk of thyroid problems and worsens its symptoms. Since thyroid condition and menopause are interrelated, their symptoms often overlap and create confusion between which condition is the culprit. In order to understand how to manage symptoms of both or either perimenopause or thyroid disorder, it’s important to understand their connection and how to differentiate between them.
What is the connection between thyroid and perimenopause?
After ovulation, the egg's outer layer produces progesterone and estrogen, which are the main hormones involved in perimenopause. “Your ovaries are also where perimenopause stems from,” Scott says. “Your whole ovarian hormones are completely different from thyroid hormones, although there is a relationship.”
In light of the fact that perimenopause affects the majority of women (usually in our 40s and into our early 50s) coupled with the increasing likelihood of hypothyroidism as you get older, it's possible for perimenopause and hypothyroidism to coexist.
During perimenopause, your estrogen levels gradually decrease and impact your thyroid hormone regulators, which play a role in regulating the activity of the estrogen receptors in your body.
A study by the National Center for Biotechnology shows that both thyroid hormones and estrogen have a significant impact on several key aspects of our health, such as body temperature, metabolism, energy, mood, and menstruation. As a result, you may experience common and overlapping symptoms during the middle stage of life.
Although menopause tends to occur in midlife, thyroid issues may develop at any stage of life. And hormonal changes due to thyroid can impact your menopause transition.
Common thyroid and perimenopause symptoms
When you get close to menopause, the boundaries between hypothyroidism and menopause may start to overlap, even if you've had hypothyroidism for a long time.
“Symptoms that are common in both perimenopause and thyroid are usually weight gain, heavy periods, dry skin, hair loss, and fatigue,” Scott explains. “If you have swings in estrogen, that can also affect your thyroid — you may have functional hypothyroidism or subclinical hypothyroidism. Therefore, they are very interconnected and it's very common for people not to know the difference.”
Kim Vopni, known as The Vagina Coach and founder and CEO of Pelvienne Wellness in British Columbia, says she began experiencing “weird symptoms” in her early 40s, including heavy painful periods, skin rashes, high cholesterol and blood pressure, anxiety, poor sleep, constipation, and no motivation for exercise and poor recovery from exercise.
“I thought my hormones were out of whack. I learned the term perimenopause and ticked a lot of the boxes. But I also ticked boxes for hypothyroidism,” she says, adding that she also experienced dry, thinning hair, dry skin, and weight gain.
Among all the symptoms she was experiencing, the ones that could have been perimenopause or Hashimoto's thyroid and overlapped were:
Dry skin
Weight gain
poor sleep
Constipation
Heavy periods
Low energy and motivation
Anxiety and heart palpitations are more commonly associated with hyperthyroid, which was also confusing for her.
Several years ago, Anu Verma, a 42-year-old English life coach and author of Victim 2 Victor, struggled to get pregnant. At the same time, her hair and skin dried out, and she felt depressed, demotivated, and tired even after sleeping eight to 10 hours. Because some of these symptoms are also related to perimenopause, Verma decided to get a blood test to see what was really going on. That’s when she was diagnosed with subtherapeutic hypothyroidism.
“I was worried — I started experiencing excruciating pain around my ovaries during ovulation, my periods were irregular and down to being only one-day periods, two days max,” Verma says in hindsight.
Verma made an appointment with an ayurvedic doctor, who recommended herbs to help balance her hormones. Instead of using chemically induced moisturizers, she switched to natural oils such as almond oil to moisturize her skin and started using Olaplex 4-in-1 Moisture Mask to help condition and moisturize her hair.
A month after taking ayurvedic medications, she felt like she’d undergone a detox. A follow-up blood test revealed that her thyroid levels had improved and she became pregnant on her first try and had her baby girl in August 2022.
How do you know if your symptoms are due to perimenopause or thyroid problems?
Due to some common symptoms of both conditions, it is normal for any woman to not understand the difference.
But there is one telltale way, says Dr. Scott: Thyroid symptoms are pretty constant day after day and you can detect a thyroid disorder with blood testing. “But you don't necessarily need blood testing to diagnose perimenopause,” she says. “It's a clinical diagnosis, which means it's just the history of your menstrual cycles because your hormones fluctuate week to week with your estrogen and progesterone.”
The symptoms of perimenopause often fluctuate. You may experience high levels of fatigue one month and not as much the next. It can feel like a roller coaster — some months your estrogen and progesterone levels are high and other months your levels are low. This can greatly impact the symptoms you experience.
Apart from professional help, you may also take some measures to know the symptoms and be aware of your body’s needs and wants.
If you are gaining weight without changing your diet, still feeling chilled, exhausted after getting eight hours of sleep, and having a swollen neck signifies that you may have an active thyroid gland. On the other hand, you are likely in perimenopause if you are occasionally hot and only get cool after a hot flash, you wake up at night with sweats, and you are gaining weight, especially around the midsection.
“The best thing to track your symptoms would be to use apps to track the duration of your menstrual bleeding. And pay attention to your energy levels around your menstrual cycle,” Dr. Scott suggests. “If you feel more tired just before your period every month but later you feel more energized, this makes it less likely that you have thyroid.”
Moreover, keep an eye on how your symptoms change or follow a pattern during your menstrual cycle. For instance, do you feel low energy and demotivation right before your period or is it constant? And as for constipation, is it only during periods or all the time? It might take some time to figure out, but it's worth a shot!
How do you manage symptoms of thyroid problems and perimenopause?
Once you understand the symptoms of either or both thyroid issues and perimenopause, the next step is to manage them. It's always best to seek help from a hormone specialist who can partner with you during the ups and downs.
Dr. Scott also advocates for making healthy lifestyle modifications, such as consuming a clean diet, to help manage both the thyroid and the perimenopause holistically. A “clean” diet consists of eliminating processed foods and avoiding added sugars and alcohol. To help reduce symptoms, Dr. Scott also recommends eight hours of sleep nightly, exercise, and managing stress.
To manage the symptoms, Vopni made changes to her diet and lifestyle, used specific supplements, and started bioidentical hormones (artificial hormones similar to those produced by the body, used to treat people with low or imbalanced hormones). Gradually her health returned and her lab work was not only “truly normal” but optimal.
“I believe women in their 40s would benefit from baseline hormone testing and a full thyroid panel that includes the antibodies,” Vopni says.