Fatigue, mood changes, irregular periods, trouble sleeping. These are all common in perimenopause, but they can also be signs of a thyroid issue. Because the symptoms overlap so much, it’s easy to assume one cause when it’s actually the other, or both.

Read on as we compare perimenopause versus thyroid disorder symptoms so you know what to look for and what to ask your provider about.

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Understanding perimenopause and thyroid dysfunction

Perimenopause refers to the transition leading up to menopause, which is when your reproductive function stops. Women commonly enter perimenopause around age 45, although it can arrive sooner or later. It’s characterized by fluctuations in hormones produced by the ovaries, particularly estrogen and progesterone. These fluctuations lead to many changes in the body, including irregular periods, hot flashes, and sleep issues.

Like the ovaries, your thyroid also produces key hormones, including thyroxine (T4) and triiodothyronine (T3). “Thyroid hormones” is the collective term for T3 and T4. They play a central role in regulating your body's metabolism, energy expenditure, body temperature, heart function, and growth and development.

Thyroid dysfunction describes abnormal thyroid hormone production, and it takes two main forms: 

• Hypothyroidism is an underactive thyroid that limits thyroid hormone production, affecting approximately 5 in 100 Americans. Common symptoms include unintentional weight gain and excessive fatigue. 
• Hyperthyroidism is an overactive thyroid that increases thyroid hormone production, leading to symptoms like rapid heart rate and increased anxiety. It's rarer, affecting approximately 1 in 100 Americans. 

Perimenopause and thyroid dysfunction: Which symptoms overlap?

Because perimenopause and thyroid dysfunction share so many symptoms, providers often check thyroid function when evaluating someone for perimenopause. The timing can overlap too. Thyroid conditions frequently show up in midlife. Hashimoto’s disease, for example, most often develops between ages 30 and 50 in women.

Fatigue is one of the most common symptoms the two share. Progesterone has a sedative effect that supports sleep. As levels shift and decline in perimenopause, that effect weakens, which can lead to restless nights and daytime exhaustion.

Fluctuating estrogen can affect sleep, too—but in different ways. As estrogen declines, many people experience vasomotor symptoms (VMS), like hot flashes and night sweats, which can interrupt sleep. 

Still, fatigue in your 40s isn’t always about perimenopause. However, fatigue isn't specific to perimenopause. It can also be a symptom of thyroid dysfunction, including both hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid). Thyroid hormones play an important role in regulating metabolism and energy expenditure. Disruptions in thyroid hormone levels can contribute to fatigue through different mechanisms. Because fatigue is common to both perimenopause and thyroid disorders, additional symptoms and, when clinically indicated, thyroid function testing can help distinguish between them. 

Here’s a side-by-side look at how perimenopause and thyroid problems compare:

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Can perimenopause cause thyroid issues?

Perimenopause doesn’t cause thyroid dysfunction, although it may contribute. There are potential links between fluctuating estrogen and thyroid dysfunction. 

For example, estrogen regulates immune cell activity, like T cells and B cells. Both cells play key roles in the body’s autoimmune responses. Fluctuating estrogen may affect their proper function, contributing to autoimmune thyroid disease (AITD). AITD is an umbrella term for autoimmune thyroid conditions, such as Hashimoto’s thyroiditis and Graves’ disease. The overarching connection isn’t well established, though. 

Similarly, thyroid dysfunction doesn’t cause perimenopause. The menopause transition is a naturally occurring process. But thyroid dysfunction can contribute to overall quality of life at this stage by adding new symptoms or worsening the ones someone is already dealing with. 

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Understanding treatment options

Once a clinician has determined the root cause of your symptoms, they’ll guide you on the right path for your body. Here are options they might discuss with you. 

Treating thyroid dysfunction symptoms 

Levothyroxine is a first-line prescription treatment for hypothyroidism. It supplements T4, one of the hormones your thyroid naturally produces. For hyperthyroidism, doctors commonly prescribe methimazole or propylthiouracil, as both limit thyroid hormone production. All these medications work by helping your body return thyroid hormone back to its normal range.

Certain conditions may prompt doctors to recommend the surgical removal of the thyroid (partial or total thyroidectomy). These can include thyroid cancer or a goiter (enlarged thyroid). As this reduces or eliminates thyroid hormone production, doctors will then prescribe synthetic alternatives. 

Treating perimenopause symptoms 

Hormone replacement therapy (HRT) is a first-line perimenopause intervention. It works by supplementing the hormones that fluctuate during this transition. There are two main types: 

• Estrogen-only therapy (ET) delivers estrogen to the system. ET alone causes the uterine lining to thicken, which increases the risk of endometrial cancer.
• Combined estrogen-progesterone therapy (EPT) delivers estrogen and progesterone. Since progesterone slows the growth of the uterine lining, doctors usually prescribe EPT to people who still have a uterus. 

The Menopause Society, a leading authority on menopause, states that HRT is the most effective treatment for VMS and genitourinary symptoms of menopause (GSM), two common perimenopause complaints. It may prove effective for other issues, too.

Based on your full health picture, your doctor may recommend an alternative if HRT is not suitable. Neurokinin receptor antagonists, for example, are one option. They’re a class of nonhormonal medications. Two of its medications—fezolinetant (Veozah®) and elinzanetant (Lynkuet®)—are FDA-approved for treating VMS. 

There are other options, too. What’s right for you depends on your health history and what you’re experiencing, which is why personalized, whole-person care matters. Work with a care team that builds a treatment plan around your symptoms, history, and life. 

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When to seek specialist guidance

If you’re experiencing novel symptoms, check in with your primary care physician (PCP). They’re typically able to identify and diagnose both thyroid dysfunction and perimenopause:

• Diagnosing thyroid dysfunction: Blood tests are a key diagnostic tool for thyroid dysfunction. Imaging, such as ultrasound, may also be employed to identify physical abnormalities in your thyroid. If diagnosis or treatment warrants additional expertise, your PCP may refer you to an endocrinologist. 
• Diagnosing perimenopause: No one blood test can reliably identify perimenopause, as hormones fluctuate frequently and unpredictably. So doctors reference multiple factors to identify perimenopause, including your symptoms, medical history, and age.

PCPs are typically able to manage perimenopause symptoms; some are even menopause specialists. These clinicians may possess a relevant certification such as Menopause Society Certified Practitioner (MSCP). If your PCP doesn’t have these credentials themselves, they may refer you to a physician with menopause-specific training and expertise.

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Navigating perimenopause with confidence at Maven Clinic

At Maven Clinic, we take a whole-person approach to hormone care, identifying the cause of your symptoms to treat them at the source. Our specialists connect the dots between what you’re feeling and what’s happening beneath the surface. Alison wrote about her experience: 

"Navigating perimenopause has been difficult. I was having symptoms, but my physical and labs came back normal. After speaking with a Maven provider, I felt like someone understood what I was going through and that I wasn't crazy!”

This whole-person approach is why millions of women trust Maven Clinic with their treatment.

Discover our approach to hormone care.