The Link Between Hypothyroidism and Menopause: What You Need to Know

Last updated 12.09.2023 | by Dr. Karen Pike | 9 Minutes Read

This article has been reviewed and fact checked by Dr. Karen Pike, a senior physician administrator and board-certified emergency room doctor actively working in northern California. Read more at our medical disclaimer page.

Hypothyroidism is the term that medics use to describe an underactive thyroid gland. It’s a condition that often affects women in their 40s and 50s, right around the time of menopause.

But hypothyroidism also shares many of the same symptoms that women commonly experience during menopause. So, it’s essential that we understand if the changes in our bodies are simply a side effect of this transitional time, or a potential symptom of hypothyroidism.

Untreated hypothyroidism can lead to severe medical issues. I routinely treat patients in the emergency room with complications such as cardiovascular problems, hypoglycemia, and respiratory issues. And in rare cases, an unmanaged hypothyroid can lead to myxedema coma, a type of coma which is classed as a life threatening emergency.

That’s why I’m committed to educating women about the signs and symptoms of hypothyroidism, and how they relate to menopause. 

So, are you worried about your thyroid health and concerned there could be an underlying issue? Are you wondering if your symptoms are caused by something more than just menopause? If so, this post is for you. 

Below, I’ll explore the link between menopause and hypothyroidism and explain how they are connected.

What is Hypothyroidism?

Hypothyroidism is a condition in which your thyroid gland stops producing enough hormones.

In healthy individuals, the brain produces thyrotropin-releasing hormone (TRH) and thyroid-stimulating hormone (TSH).

TSH sends signals to the thyroid gland, prompting it to produce a hormone called T4 (thyroxine). Your body then converts T4 into another hormone called T3 (triiodothyronine), which your cells need to function correctly.

T3 is known as the “active thyroid hormone.” That’s because it does most of the heavy lifting when it comes to metabolizing food, controlling your temperature and heart rate, storing and burning energy, and managing your weight. It also affects your cognitive function and how you sleep.

When a person has hypothyroidism, their body’s ability to either produce T4 or convert it into T3 is compromised.

It’s still unclear why some people develop hypothyroidism, but most cases are caused by the immune system going into overdrive and attacking the thyroid gland.

Doctors usually treat hypothyroidism with oral hormone replacement tablets, which compensate for the lack of thyroid hormones.

Do Hypothyroidism and Menopause Share the Same Symptoms?

Do Hypothyroidism and Menopause Share the Same Symptoms

Yes! A lack of essential thyroid hormones can cause:

And, as many women in their 40s and 50s know all too well, these are also symptoms that can appear during menopause.

That being said, hypothyroidism can also cause symptoms not commonly associated with menopause, such as:

  • Goiter: a visible swelling in the neck
  • An increase in blood cholesterol level
  • An increase in sensitivity to cold
  • A puffy face
  • A hoarse voice

Is it Hypothyroidism or Menopause?

Since hypothyroidism and menopause share so many of the same symptoms, and thyroid issues affect a disproportionate number of middle-aged women, many of my patients are unsure how to tell the two apart.

And unfortunately, it’s often impossible to do so without proper testing. That’s why if you notice symptoms such as unexplained weight gain, fatigue, brain fog, or hair loss, it’s important to see your doctor.

Thyroid conditions are surprisingly common in women, and the only way to know the true cause of your symptoms is with an accurate medical diagnosis. Luckily, in most cases, simple blood tests can give you the answers you need. (More on this later.)

Can Menopause Cause Hypothyroidism?

While there is no definitive evidence that menopause directly causes hypothyroidism, the two are interlinked. Not only do they share the same symptoms, but they can also influence and exacerbate one another.

In fact, it’s thought that menopause can trigger hypothyroidism in women who are already predisposed to the condition.

During perimenopause (the build-up to menopause) and menopause, the body begins producing significantly less estrogen. This drop in estrogen is responsible for many of the most troublesome symptoms of menopause.

But declining estrogen doesn’t just lead to hot flashes, night sweats, and mood swings. It also has other effects.

According to research, estrogen plays a key role in regulating thyroid receptors. So, when estrogen suddenly drops, it can lead to a decrease in thyroid function.

What Factors can Increase My Risk of Developing Hypothyroidism?

What Factors can Increase My Risk of Developing Hypothyroidism

We know that menopause can trigger hypothyroidism in women who are vulnerable to developing the condition. But several other risk factors can increase your chances of being diagnosed with an underactive thyroid, including:

  • Stress
  • Aging
  • Pre-existing autoimmune diseases
  • Treatment for hyperthyroidism (an overactive thyroid)
  • Previous thyroid surgery
  • Genetics and family history
  • Cancer radiation therapy in the head and neck region
  • Certain medications
  • A defective thyroid gland
  • Pregnancy
  • Iodine deficiency
  • Malnutrition
  • Hormonal imbalances

Being female also increases the risk of developing hypothyroidism. In fact, women are 8 to 9 times more likely to develop the condition than men.

How Does Hypothyroidism Affect Menopause Symptoms?

If you’ve been diagnosed with hypothyroidism and you’re a woman in your 40s or 50s, you might notice an increase in the symptoms of menopause.

Lower levels of estrogen can also worsen your already underperforming thyroid gland. This can lead to increased weight gain, worsened depressive moods, and many other overlapping symptoms.

However, there is good news. Research suggests that treating the underlying thyroid disorder can dramatically improve symptoms of menopause, too.

Does Hypothyroidism Increase the Risk of Complications During Menopause?

If an underactive thyroid is left untreated, it can increase your risk of developing long-term and potentially serious complications during menopause and postmenopause.

One of the most common concerns for women during and after menopause is a loss of bone density. This can lead to a condition called osteoporosis.

Hypothyroidism can also contribute to bone loss. So if you’re a menopausal woman with an underactive thyroid, it’s important to take steps to improve bone density to reduce your risk of fractures. I’ve treated countless women for serious fractures in my work as an emergency room doctor, and many of these fractures might have been avoided if bone loss and osteoporosis hadn’t played a role.

Post-menopausal women are also at an increased risk of developing heart disease, and low levels of thyroid hormones can increase this risk further.

So, if you suspect that you may have a thyroid issue, it’s crucial to visit your doctor. They can assess your symptoms, confirm your diagnosis, and put you on a treatment plan that could significantly improve your quality of life and help you avoid problems in the future.

Diagnosing Hypothyroidism

Diagnosing an underactive thyroid is a relatively simple process. In most cases, we use blood tests to determine a patient’s level of thyroid function and pinpoint any issues such as hypothyroidism.

TSH levels

Your doctor will likely perform a blood test to check your TSH (thyroid-stimulating hormone) levels. TSH increases when your thyroid becomes less active. So, a high reading of this hormone suggests an underactive thyroid. Conversely, low levels of TSH point to an overactive thyroid (hyperthyroidism).

Most doctors will test TSH levels before measuring other hormone levels. This is because if your TSH is within the normal range, it’s highly unlikely that you have an underactive thyroid.

Other blood tests that can help confirm a diagnosis include:

T4 levels

T4 (thyroxine) is another type of thyroid hormone which, if found to be low, could indicate hypothyroidism. 

T3 levels

The thyroid hormone known as T3 (triiodothyronine) generally stays close to a normal range until hypothyroidism becomes severe. So, it’s usually used in conjunction with other tests listed above.

Subclinical Hypothyroidism

If TSH levels are high, but T4 and T3 levels remain in the normal range, you will likely be diagnosed with a condition known as subclinical hypothyroidism (SCH).

Subclinical hypothyroidism is relatively common. Research suggests that it affects 3-12% of women. Most women are unaware that they have the condition since it usually presents no symptoms.

However, subclinical hypothyroidism puts you at a much greater risk of developing true hypothyroidism. So, receiving an accurate diagnosis is important. That way, you can take steps to prevent the condition from worsening during and after menopause.


Do the symptoms of an overactive thyroid (hyperthyroidism) also mimic symptoms of menopause?

An overactive thyroid (hyperthyroidism) is the opposite of an underactive thyroid (hypothyroidism). However, some of the symptoms of an overactive thyroid can also mimic those found in menopause, including:
Mood swings
Muscle weakness
Increased urination
Loss of libido

How does hormone replacement therapy (HRT) affect hypothyroidism?

Oral forms of HRT can impact the bioavailability of the thyroid hormone T4. So, hypothyroidism can actually get worse when taking HRT. As a result, you may notice your symptoms become worse too.
If you’ve been diagnosed with hypothyroidism and you’re taking a course of HRT, talk to your doctor as soon as possible. They may need to adjust your dosage or switch you to a different treatment plan that can better support your needs.

Can hypothyroidism induce early menopause?

Yes. There is evidence to suggest that hypothyroidism can increase the chances of experiencing early menopause. This is due to the effect the condition has on the body’s hormone levels.
However, there is some good news. Proper treatment of hypothyroidism can prevent the onset of premature menopause in most women. So, it’s important to seek medical advice as soon as possible.


Menopause shares many of the same symptoms as hypothyroidism. And fluctuating estrogen during perimenopause and menopause can also trigger hypothyroidism in women who are predisposed to the condition.

So, it’s important to pay attention to any changes in your body and visit your doctor if you have any concerns.

Diagnosing hypothyroidism is the first step to regaining your health and wellness so that you can journey through menopause with confidence and vitality.



  • Dr. Karen Pike

    Dr. Pike is a senior physician administrator and board-certified emergency room doctor actively working in northern California. She received her undergraduate degree at Dartmouth College, where she graduated Phi Beta Kappa and played collegiate soccer. She attended Georgetown University for medical school and performed her residency in emergency medicine at Stanford University. She was part of the first-ever, women-majority emergency medicine program in United States. Dr. Pike is also the primary medical consultant for “Grey’s Anatomy,” a role she has held since the pilot episode when she partnered with Shonda Rhimes as the show’s original medical consultant. At her hospital, she was the second woman Chief of Staff. Today serves as the Director of the Emergency Department. Whether in leadership or direct patient care, her dedication to excellence in communication, quality, and collaboration is unwavering.