We all know by now that symptoms such as fatigue, brain fog, weight gain, anxiety, hair loss, temperature swings and joint pain are some of the classic symptoms of perimenopause and menopause.
But what’s less commonly discussed is that thyroid issues can cause almost exactly the same symptoms.
This overlap means it’s easy for thyroid problems to be mistaken for menopause, or missed entirely. And for women who are already on HRT but still don’t feel quite right, an undiagnosed thyroid imbalance may be the reason.
Watch the video below or listen to the podcast (episode 169);
Why menopause and thyroid issues overlap
Your thyroid gland is vital in regulating metabolism, energy, temperature, mood, and even hair and skin health. Thyroid problems become more common with age, especially in women.
At the same time, falling oestrogen and progesterone levels during the menopause transition affect almost every body system, from sleep and brain function to bone health and emotional regulation. The result? A long list of symptoms that can look remarkably similar, whether they’re caused by hormonal changes, thyroid dysfunction, or both.
Common symptoms that overlap
Here are some of the key symptoms that can appear in both menopause and thyroid dysfunction:
- Persistent fatigue and low energy
- Unexplained weight gain, or difficulty losing weight
- Brain fog and problems concentrating
- Low mood, anxiety or feeling emotionally flat
- Thinning or hair loss
- Changes in temperature regulation (hot flushes, feeling cold, night sweats)
- Joint or muscle pain and stiffness
- Dry skin
- Irregular or absent periods (in perimenopause, this is a defining feature; with thyroid issues, it can sometimes occur too)
Because there’s so much crossover, it’s easy to see why many women are told “it’s menopause” and started on HRT, which can be genuinely helpful, but if an underlying thyroid issue isn’t picked up, they may only get partial relief or none at all.
Why thyroid issues are often missed
In standard GP testing, thyroid assessment can be quite limited. Often, only TSH (thyroid-stimulating hormone) is measured. If it falls within the “normal” range, the thyroid is usually declared “fine” — even if symptoms persist.
In reality, thyroid health is more nuanced than one marker. A comprehensive thyroid panel should include:
- TSH – the signal from the brain to the thyroid
- Free T4 and Free T3 – the actual hormones that influence metabolism and energy
- Thyroid antibodies – to detect autoimmune thyroid disease (common in midlife women)
This fuller picture can uncover early or subtle thyroid issues that standard tests often miss.
When HRT alone isn’t enough
HRT can be transformative, restoring energy, mood, cognitive function and more. But if you’ve been on HRT for several months and still feel tired, foggy, anxious, or not yourself, it’s worth looking beyond menopause alone.
Thyroid dysfunction, particularly hypothyroidism and autoimmune thyroiditis (Hashimoto’s), is common in midlife women.
The good news: you can find out
The best way to separate menopause from thyroid issues is through comprehensive blood testing. This gives us a more accurate picture of:
- Your sex hormones (to assess menopausal status and HRT effectiveness)
- Full thyroid function (TSH, Free T4, Free T3, antibodies)
- Key nutrients that support both hormone and thyroid health
This level of testing is often not available through routine GP care, but it can make all the difference in identifying what’s really driving your symptoms and creating a targeted plan.
So if you’re experiencing menopause-like symptoms but not feeling the full benefits of HRT, don’t overlook your thyroid. These two systems are closely intertwined, and thyroid dysfunction is both common and treatable.
If you'd like more information about our testing and how we can support you, please get in touch.