What Causes Menopause?
Menopause is a natural transition that women experience, and it’s the permanent end of menstruation. After a woman has had her final period and doesn’t menstruate for 12 consecutive months, she’s been through menopause.
During perimenopause — the time leading up to menopause — and menopause, hormonal fluctuations are common. This can even be when hypothyroidism develops in some women. “One theory is that fluctuation in estrogen levels may increase inflammation, creating the ideal environment for development of autoimmune diseases such as Hashimoto’s thyroiditis, which may lead to hypothyroidism,” says Cheryl R. Rosenfeld, DO, the senior managing partner at North Jersey Endocrine Consultants in Parsippany, New Jersey, and an assistant professor of medicine at the New York College of Osteopathic Medicine in Old Westbury, New York. The drop in estrogen is what causes menopausal symptoms.
Hypothyroidism occurs when the thyroid gland does not make enough thyroid hormone. The most common cause is inflammation of the thyroid, but it may also be due to a number of other causes, including too much or too little iodine in the body, taking medications such as lithium, and inflammation of the thyroid, according to the American Thyroid Association.
Menopause and Hypothyroidism Share Many Symptoms
Even if you’ve had hypothyroidism for a while, when you reach menopausal age, the lines between hypothyroidism and menopause can start to blur. “Symptoms of hypothyroidism can be confused with symptoms due to the menopause transition,” says Ekta Kapoor, MBBS, an endocrinologist in the Menopause and Women’s Sexual Health Clinic at the Mayo Clinic in Rochester, Minnesota.
These same symptoms can include:
- Altered length of menstrual cycle
- Change in amount of bleeding
- Sleep disruption
- Fatigue
- Mood swings
- Forgetfulness
- Weight gain
- Dry skin
- Hair loss
Dr. Rosenfeld cautions against using synthetic thyroid hormone medication to alleviate menopause symptoms in women with normal thyroid function. “While there is a great deal of overlap in the symptoms, if the thyroid blood tests are normal, it would be wrong to treat a person without thyroid disease with thyroid hormone or to increase thyroid hormone in a person with hypothyroidism to alleviate symptoms of menopause,” she says. “Thyroid hormone is not a ‘cure-all’ for symptoms — it is a treatment for hypothyroidism.”
If you’re looking for a clue as to what’s causing your issues, check your body heat — hot flashes and night sweats are unique to menopause, says Dr. Kapoor. But there is an exception: “Over-replacement with thyroid hormone can also cause hot flashes and night sweats,” notes Kapoor. So work with your doctor to ensure you are getting an appropriate amount of thyroid hormone treatment. If you are and you’re still waking up sweating, that’s a good indication that you are indeed experiencing menopause symptoms.
Managing Hypothyroidism During Menopause
Hypothyroidism can worsen menopause symptoms. So rather than shrug off your symptoms, it’s important to maintain hypothyroidism treatment during menopause. “Undertreated thyroid disease may cause increased cholesterol, leading to atherosclerosis and possibly heart attack or stroke,” says Rosenfeld. In addition, hypothyroidism may cause high blood pressure, leading to similar heart complications. Overtreatment with thyroid hormone is also a known cause of osteoporosis, Kapoor adds.
Doctors know to adjust thyroid treatment based on your current needs, and that includes during menopause. “When estrogen levels drop at the time of menopause, people who are on levothyroxine to treat hypothyroidism may experience a change in their thyroid hormone needs, usually downward,” says Rosenfeld. And conversely, hormone therapy — which is commonly used to treat menopause symptoms — can necessitate the opposite. “If a woman treated with thyroid hormone starts estrogen, her dose of levothyroxine may have to be increased,” says Kapoor.
One study stated that the decision to use hormone therapy for menopause should be individualized in women with thyroid disorders such as hypothyroidism.
