Around your fiftieth the doubt sets in: is this the menopause, or is something wrong with my thyroid? During menopause and with an underactive thyroid the complaints overlap strongly: fatigue, weight gain, mood swings and poor sleep belong to both. So an underactive thyroid around that age is easily taken for "just the menopause". You do not make the distinction on feeling, but with blood values: TSH and free T4 for the thyroid, FSH and oestradiol for the menopause.
In my experience, precisely because both can be at play at once, it is valuable to know what causes what. Otherwise you treat the menopause while your thyroid is the real engine of your complaints, or the other way round. Below you will read how to tell them apart.
Why do menopause and thyroid look so alike?
Your sex hormones and your thyroid work together. Oestrogen affects how much thyroid hormone is freely available in your blood, and that balance shifts during menopause. On top of that, the risk of an underactive thyroid rises with age, exactly in the period when menopause occurs.
The result: two different causes with almost the same complaints. For the thyroid side, read our explanation of underactive thyroid symptoms in women.
Menopausal complaint or thyroid? A comparison
Some complaints point a little more to the menopause, others to the thyroid. The table helps you make the distinction; only a blood test gives certainty.
| Complaint | Fits menopause | Fits underactive thyroid |
|---|---|---|
| Hot flushes and night sweats | Yes, characteristic | Rarely |
| Feeling cold constantly | Less typical | Yes, characteristic |
| Irregular period | Yes | Can, often heavier |
| Weight gain | Often | Often |
| Dry skin and hair loss | Can | Yes, characteristic |
If you mainly see hot flushes, the menopause is likely. If you are constantly cold with dry skin, the thyroid deserves attention. When in doubt, measure both.
Which values give clarity?
For the thyroid you look at TSH and free T4. For the menopause at FSH and oestradiol. Measured together, you see in one go which way your complaints point, or whether both are at play.
For the menopause side, read our explanation of navigating perimenopause. Many hormone panels for women include TSH by default, precisely because of this overlap.
What if both are at play?
It happens that a woman in menopause also develops an underactive thyroid. Then it helps to know which part of your complaints comes from what, so a next step is targeted. An underactive thyroid in menopause sometimes calls for separate attention alongside the menopause itself. The NHG (Dutch College of General Practitioners) thyroid guideline notes that thyroid complaints become more common with age, so in this life stage they can be worth testing.
At Lunara the Menopause test measures the menopausal hormones, and you can include the thyroid values for a fuller picture. To look broadly at the female hormones at once, the Hormones Women test looks wider. This article belongs to our overview of thyroid symptoms in women.
When is testing wise?
If your complaints last longer than a few weeks, or you recognise both menopausal and thyroid signals, a combined measurement gives the most clarity. On Thuisarts.nl it states that unexplained, persistent complaints are a reason to consider blood testing. You always discuss an abnormal result with your GP, who arranges further investigation if needed.
Why the distinction matters for your approach
It seems a detail, but knowing whether your complaints come mainly from the menopause or from the thyroid determines which next step is logical. Menopausal complaints and an underactive thyroid call for a different approach: the first is about guiding a natural life stage, the second possibly about following up a thyroid value in consultation with your doctor.
If you treat the wrong track, part of your complaints will persist and you grow frustrated that "nothing helps". That is why a measurement that brings both sides into view is so valuable: you invest your energy and attention in the cause that truly matters. A low-normal or borderline value does not automatically mean something must be done; it mainly gives direction to the conversation with your doctor and to a possible repeat measurement.
Frequently asked questions
Does an underactive thyroid start more often around menopause?
The risk of an underactive thyroid rises with age, so around menopause it relatively often comes to light. Whether it is truly caused by the menopause cannot always be said; a blood test gives clarity about the values.
Can I test both at once?
Yes. Thyroid values (TSH, free T4) and menopausal hormones (FSH, oestradiol) can be measured in one blood draw. So you do not need to test twice to make the distinction.
Does hormone therapy also help with thyroid complaints?
Hormone therapy targets menopausal complaints, not the thyroid. If your complaints come (partly) from the thyroid, that calls for its own approach. Discuss this with your GP.
Sources
- NHG Guideline Thyroid Disorders (M31). Dutch College of General Practitioners. Available via nhg.org.
- Thuisarts.nl, I am going through the menopause. Dutch College of General Practitioners. Available via thuisarts.nl.
Every blood test result via Lunara includes a professional review by a BIG-registered doctor. For treatment decisions, discuss your results with your GP.
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