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Many middle-aged women experiencing menopausal-like symptoms may be experiencing thyroid-related problems. They are often difficult to tell apart but lab tests may help with the diagnosis.

Millions of women with menopausal-like symptoms may be suffering from undiagnosed thyroid disease. These non-specific symptoms consist of fatigue, depression, mood swings, weight gain, irregular menstrual periods, and sleep disturbances.

These are frequently associated with menopause, especially when they occur in women who are in their 40s.

However, only one out of four of these women who have described these menopause-like symptoms with a physician are actually tested for thyroid disease.

Perimenopausal Symptoms

It is common for women in their late 40s to their early 50s to expect the symptoms of menopause. This perimenopausal stage is the period when the signs and symptoms of menopause have not stabilized. Menopause is defined as the complete cessation of menstrual periods and loss of fertility. Before this occurs, a woman may undergo a long transition stage, called perimenopause, which may start as early as their mid-30s, although most women experiences changes in their mid to late 40s. This transition period may last for five to ten years, during which, one may undergo these signs and symptoms:

  • Irregular menstrual periods
  • Longer or shorter periods
  • Heavy menstrual flow or spotting
  • Absent periods
  • Menstrual cramping
  • Breast tenderness
  • Premenstrual syndrome, or PMS, which consists of fatigue, irritability, food cravings, and depression
  • Sleep problems
  • Hot flushes alternating with intermittent coldness
  • Weight gain
Menopause is a natural stage in a woman’s life that begins with a gradual decline in estrogen levels and ends with cessation of menses and with the ovaries failing to release eggs.

Symptoms related to these hormonal changes may come and go, some days being better than others are, especially during the long perimenopausal stage. For some women, undergoing these changes may be very challenging and they may feel that these are unnatural or perhaps related to some other health condition. They may seek medical consultation for vague symptoms, for which they may not get satisfactory treatment.

However, the diagnosis of menopause is usually made retrospectively, since it is established only a year after menses disappear.

Read More: Premature Menopause: Causes, Symptoms, And Beyond

Thyroid Symptoms Can Mimic Menopause

The thyroid is a butterfly-shaped gland located on the front of the neck but is normally not visible or felt. It produces several hormones, called thyroid hormones, which act throughout the body, influencing metabolism, growth, and development, and regulating body temperature.

Thyroid disorders can mimic the symptoms of perimenopause, and even physicians may be misled to treat these patients’ complaints as menopausal signs. A woman whose thyroid is functioning less than it normally should may experience irregular menstrual periods, depression, fatigue, depression, and weight gain just as a perimenopausal woman would undergo.

Because of these similarities, middle-aged and older women may be given hormone replacement therapy and calcium supplementation, which do not result in the improvement of their symptoms.

While there is a blood test that can help diagnose menopause - Follicle-stimulating hormone (FSH) and estrogen (estradiol) test - a physician can order more blood tests to look into other conditions, including a thyroid screen, which may reveal a condition called hypothyroidism.

What is Hypothyroidism?

Hypothyroidism is a condition where the thyroid produces low levels of thyroid hormones.  This results in an imbalance in the metabolic and chemical reactions in the body.

It can make a woman feel tired and weak all the time. It can cause sleep problems that make them suddenly awaken at night and have difficulty falling back to sleep. This also causes them to feel more tired during the day. Furthermore, hypothyroidism is sometimes accompanied by symptoms of depression. If not treated, hypothyroidism can increase blood cholesterol levels and make one more prone to a heart attack or stroke. Untreated hypothyroidism can also harm an unborn baby.

Men and women of any age can get hypothyroidism, but older adults especially women aged 60 and older have the highest risk. One is also more likely to get the disease if it runs in the family or if one has an autoimmune disease, underwent thyroid surgery, or had radiation therapy.

Diagnosing Hypothyroidism

Fortunately, hypothyroidism can easily be diagnosed from blood tests called thyroid screen once the condition is suspected. As mentioned earlier, however, only a quarter of women who present with clinical manifestations similar to menopausal symptoms are screened for hypothyroidism.

Thyroid screen consists of a thyroid-stimulating hormone (TSH) test, which demonstrates an increase in amount of TSH in the blood. It is considered the most reliable way to uncover a thyroid problem, especially when paired with a blood test for free thyroxine (T4), a thyroid hormone that is decreased with a hypo-functioning gland.

Once diagnosed, hypothyroidism is easily treatable with thyroid hormone pills, which will result in improvement of symptoms within two weeks.

Are You Experiencing Menopause or Hypothyroidism?

Many of the symptoms of menopause and hypothyroidism may be alike and can lead to confusion since these may occur around the age of menopause (40 to 58 years old). Furthermore, symptoms may not be consistent or clearly defined. Women and their doctors may take these symptoms for those related to perimenopause and may try treatments directed at relieving them without addressing the underlying condition. Since there are usually no laboratory tests for menopause, both patient and doctor may be misled.

However, a simple blood test or thyroid screen can easily lead to the diagnosis of hypothyroidism if it is suspected.

It is therefore advisable to discuss these concerns with a physician rather than assuming that your symptoms are just due to normal aging process or menopause, especially if remedies for menopausal-like symptoms do not seem to work. A TSH level that is higher than normal and T4 levels that are low indicate that you are most probably suffering from hypothyroidism.

Read More: Hypothyroidism and the weight battle

 When lab tests show altered TSH and T4 levels, further tests may be done to determine the cause of your thyroid problems. An antibody test may be needed to determine if you have an autoimmune condition called Hashimoto's thyroiditis.

In this condition, the body's immune system attacks your thyroid gland, causing it to malfunction. Doctors may also ask for imaging tests to evaluate the thyroid gland if it appears to have physical abnormalities such as an increase in size or presence of lumps. These include a thyroid ultrasound and a thyroid scan. Further studies on the brain, which also influences thyroid gland function, may also be needed, and these include a CT (computed tomography) scan or an MRI (magnetic resonance imaging) of the brain.

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