Menopause and the thyroid

If you’ve been following us, you know that we care a lot about the thyroid gland and its role in maintaining optimal wellness. We care so much about it because we’ve had personal experiences with its role in our health and that of our patients — both the extreme deterioration of health when the thyroid is not functioning properly, and then the restoration of health once supported.

As a reminder, the thyroid is a butterfly-shaped gland in the lower front of the neck. Its primary job is to produce hormones that regulate a variety of functions within the body, including metabolism, heart function, digestion, muscle control, bone maintenance, mood regulation, and brain development.

More and more people, especially women, are developing thyroid conditions, which include hypothyroidism and hyperthyroidism. Hypothyroidism occurs when someone has an underactive thyroid, meaning the body is not producing enough of certain important hormones. Hyperthyroidism occurs when someone has an overactive thyroid, producing too much T3, T4, or both. It’s also possible to have an autoimmune condition, such as Hashimoto’s or Graves’ disease — when the immune system is attacking and destroying the thyroid.

Is it menopause or my thyroid?

When menopausal and postmenopausal women are having symptoms, it’s tricky to tease out whether they’re related to menopause or a thyroid condition. Look at how much they overlap:

The thyroid in postmenopausal women

We know that thyroid conditions mostly affect women, and that the incidence of thyroid conditions increases with age. Conditions such as autoimmune thyroid disease, hypothyroidism, nodular goiter, and cancer happen most often in elderly and postmenopausal women.¹ However, identifying thyroid conditions in postmenopausal women can be tricky, as many thyroid symptoms overlap with menopausal symptoms and ovarian dysfunction. Interpretation of thyroid tests can also be more complicated in the older population.¹ We recommend a number of thyroid tests to see if the thyroid is functioning properly.

It’s also important to note that iodine may play a role in thyroid health. Iodine is an important element needed for thyroid hormone production, and up to a third of people worldwide are at risk for iodine deficiency disorders.² Not only does iodine intake matter, but iodine uptake also matters. As we age, the thyroid’s ability to take up iodine decreases — in people over 80 years old, this ability is 40% less than in those who are 30. Iodine levels should always be checked to ensure that dietary intake is enough to support the production of thyroid hormones.

Does menopause affect the thyroid?

We know that symptoms caused by menopause are primarily due to all of the hormonal changes that occur with menopause. One of the primary hormones we’ve discussed is estrogen, and how the decrease of estrogen during and after menopause leads to a variety of issues and symptoms in the body.

The decrease in estrogen also plays a role in thyroid health. Some data suggests that estrogen can play a role in how thyroid receptors allow thyroid hormones to enter into cells, affecting cellular and thyroid function.³ More research is needed to explore the relationship between estrogen levels, thyroid receptors, and thyroid health.

Does thyroid health affect menopause?

Women with compromised thyroid health may also have more severe menopausal symptoms. In a research study with 350 women with menopausal symptoms, 21 women had hypothyroidism and 18 women had hyperthyroidism. These women experienced much improvement in menopausal symptoms after being treated for their thyroid conditions.⁴

Thyroid conditions may also increase the risk of menopausal complications. For example, osteoporosis is a concern during menopause as well as with hypothyroidism.⁵ With menopause and hypothyroidism, there is even more concern. The same is true of cardiovascular disease and heart conditions — an issue with hypothyroidism⁶ and with menopause, and the combination of the two is concerning for the body.

Additionally, during menopause the body relies more on the adrenal gland for proper hormone function. If there is a thyroid condition, the body will rely even more on the adrenal gland, which can be very problematic. Researchers have established a relationship between thyroid health and adrenal gland health.⁷ Certain autoimmune conditions can destroy both the thyroid gland and the adrenal cortex, which can cause hormone deficiencies.⁸ Beyond autoimmune conditions, researchers are studying how the underproduction or overproduction of thyroid hormone can affect adrenocortical hormone deficiency or excess.⁹ More research is needed to fully understand this relationship.

Why we test early

Clinically, we see a higher incidence of thyroid conditions in menopausal women. As mentioned, menopausal women may have an iodine deficiency due to inadequate intake or reduced uptake ability. We also suspect that decreases in estrogen levels affect how thyroid hormones are able to enter cells in the body.

We also know that women often have subclinical thyroid conditions. While their thyroid lab ranges appear normal in conventional testing, when we dig deeper we find that the thyroid is not working optimally. Subclinical thyroid conditions may have some of the same symptoms as a clinically recognized thyroid condition (and similar symptoms to menopause). As a rule of thumb, we don’t wait for the person to fall apart to act. If a thyroid issue is suspected, we run a variety of thorough tests — including labs and imaging — to verify the issue and address it.