Thyroid dysfunction is ten times more likely to occur in women than men and is increasingly common during and after menopause making this a very important aspect of women’s health.
Nature dictates that all women will go through the menopause. Many will also have co-existing thyroid disease. Managing both effectively, tailored to individual needs, improves one’s health and can also significantly enrich one’s quality of life.
Thyroid disease occurs when too much or too little of certain hormones are made. There are many reasons why this occurs including disruptions in the signalling pathways, autoimmune thyroid disease, post-operative consequences and most commonly idiopathically (just one of those things!).
Understanding thyroid disorders and how their symptoms can overlap with menopause is key to ensuring you receive the right care.
What is the thyroid?
The thyroid gland is a hormone-producing gland located at the front of the neck, under your voice box. It is shaped like a butterfly, with the two lobes lying around the windpipe.
It plays a major role in your metabolism, and it regulates many bodily functions by constantly releasing a steady amount of the thyroid hormones Triiodothyronine (T3) and Tetraiodothyronine (T4), also called thyroxine.
Thyroid disorders arise when too much or too little of these hormones are produced and this can give rise to a range of challenging symptoms.
Underactive thyroid (hypothyroidism)
An underactive thyroid is where your thyroid gland doesn’t produce enough hormones to meet your body’s needs, and your metabolism slows down. Both men and women can have an underactive thyroid, but it’s more common in women, affecting 15 in every 1,000. Your risk of developing an underactive thyroid increases with age. It is common for women going through menopause to also have an underactive thyroid and it’s estimated that 12–20% of women over 60 may have an underactive thyroid.
In the UK, the most common causes of an underactive thyroid are:
- Hashimoto’s disease where the body's immune cells mistakenly damage the thyroid gland and stop it from working.
- Side effects of treatment for thyroid cancer or an overactive thyroid, such as surgery or radioactive iodine treatment.
Symptoms of underactive thyroid
Symptoms of an underactive thyroid can overlap with symptoms of other conditions and often develop gradually, meaning you may not notice them for some time. They can include:
- Tiredness and fatigue
- Weakness
- Weight gain
- Dry skin and hair
- Warm or red skin
- Low mood, including depression
- Difficulty concentrating
- Forgetfulness
- Constipation or increased bowel movements
- Nervousness
- Heart palpitations or fast heart beating
- Breathing problems
- Increased sensitivity to the cold
- Increased sweating
- Sleep disturbances
If an underactive thyroid isn’t treated, it can lead to more serious health implications such as:
- Heart disease
- Goitre
- Pregnancy complications
- Myxoedema coma (rare)
Treatment of underactive thyroid
Levothyroxine is the usual treatment for an underactive thyroid. It is a daily hormone replacement medication that replaces the thyroxine that your body doesn’t make enough of.
You’ll normally need treatment for the rest of your life and initially, you’ll have regular blood tests until the correct dosage is determined. This can take a little time to get right and while some people will start seeing improvements in their symptoms quickly, others won’t notice any difference for several months. Once on the right dose, you’ll have monitoring blood tests annually.
Overactive thyroid (hyperthyroidism)
Having an overactive thyroid is less common, but it is still ten times more likely to affect women than it is men and typically happens between the ages of 20 and 40.
It is a disorder where the thyroid produces too much of the thyroid hormones and several conditions can cause your thyroid to become overactive including:
- Graves’ disease where your immune system produces antibodies that cause your thyroid to produce too much thyroid hormone.
- Thyroid nodules (lumps on your thyroid).
- Medication, such as amiodarone, most often used to treat an irregular heartbeat.
- A pituitary adenoma (a non-cancerous tumour in the pituitary gland)
- Swelling of the thyroid (thyroiditis)
- Thyroid cancer
Symptoms of overactive thyroid
An overactive thyroid can cause a wide range of symptoms including:
- Mood swings
- Nervousness, anxiety and/or irritability
- Hyperactivity
- Sleep problems
- Chronic tiredness
- Muscle weakness
- Sensitivity to heat
- Excessive sweating
- Heart palpitations
- Twitching or trembling
- Swelling in your neck from an enlarged thyroid gland
- Weight loss
- Diarrhoea
- Needing to urinate more frequently
- Persistent thirst
- Reduced libido
- Itchiness and/or hives
Without treatment, an overactive thyroid can sometimes lead to further problems, including:
- Eye problems including irritation, double vision or bulging eyes
- Pregnancy complications
- A thyroid storm – a side and life-threatening symptom flare-up
Treatment of overactive thyroid
There are three main treatments for an overactive thyroid:
- Medications called thionamides which stop your thyroid from producing excess hormones.
- Radioactive iodine treatment is a type of radiotherapy used to destroy cells in the thyroid gland.
- Surgery to remove part or all of your thyroid.
Supporting thyroid health
Many of the lifestyle changes that can help you optimise your thyroid health also contribute to overall well-being and the management of menopause symptoms. These include:
- Eating a balanced diet rich in A, vitamin D, zinc, iodine and selenium.
- Reducing stress through exercise, meditation, yoga and other mindfulness practices.
- Drinking plenty of fluids.
- Avoiding processed foods and reducing your sugar intake.
- Getting sufficient sleep.
How to tell the difference between thyroid and menopause
An overactive thyroid and menopause can produce many similar symptoms, so it isn’t always easy to determine the underlying cause, and hypothyroidism can actually worsen menopause symptoms. In addition, the naturally occurring hormonal fluctuations during perimenopause can create a situation where autoimmune diseases like Hashimoto's can develop, which can lead to hypothyroidism.
Menopause symptoms include:
- Menstrual irregularities
- Hot flushes
- Night sweats
- Mood changes
- Weight gain, especially around your middle
- Sleep issues
- Palpitations
If you are experiencing these symptoms and are between the ages of 45 and 55, you have likely reached perimenopause. You can learn more in our guide to perimenopause. However, many menopausal women also have an underactive thyroid. The only way to confirm this is to have a thyroid function blood test.
Can HRT affect your thyroid?
Hormone replacement therapy (HRT) is a safe and effective treatment for menopause symptoms, with the benefits largely outweighing any HRT risks. If you have normal thyroid function, you’ll likely adapt well to HRT, and it will not have any adverse effects on your thyroid.
Approximately 5% of menopausal women receive HRT and thyroid hormone replacement. Many women find that taking HRT improves their thyroid function, although certain types of HRT may require your dose of levothyroxine to be increased. Most importantly it is vital that the two areas are considered together when making dose adjustments or starting HRT.
If you’re experiencing symptoms that are impacting your day-to-day life, it's a good idea to speak to a specialist who can help you determine their root cause and provide you with a tailored healthcare plan. At Menopause Care, we have menopause doctors with specialism in thyroid health. They are experienced in how menopause and thyroid disorders are interlinked and can provide you with evidence-based guidance and treatment. Take the first step by booking a consultation with a menopause doctor.
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