Is it My Thyroid? Or Perimenopause?
This post was originally published in September of 2019 and has received several updates.
There comes a time in many women’s lives when they ask themselves, “Is this perimenopause? Or is it my thyroid? Or maybe both?”
They’ll say, “I’ve lost my edge—I haven’t felt like myself for a while.” They may feel unusually down and fatigued. Or even depressed. And perhaps a little anxious at the same time. Or irritable. There are the extra few pounds around the middle, the mood swings, the diffuse hair loss, the low libido, the dry skin that’s lost some of its luster, and the irregular or heavy menstrual cycles.
To varying degrees, these worries are pretty rampant for “modern” women who are “doing it all” and trying to be all things to everyone. And it’s easy to chalk at least some of these symptoms up to “getting older.” For many women, being in pre-menopause or being perimenopausal indeed means “getting older.”
But I don’t believe that women in their 40s and 50s (or even 60s or 70s for that matter) are “old!”
Quick pause for definitions:
- Pre-menopause is the stretch of reproductive years approaching the age of 51 (the average age of menopause).
- Perimenopause (peri means near or around) is the transitional phase leading up to menopause and often includes symptoms associated with hormonal shifts. Including those listed above, many women experience hot flashes, night sweats, sleep disruption, brain fog, vaginal dryness, and changes in libido).
- Menopause is a single point in time: 12 months without a cycle.
Keep in mind, the word “perimenopause” wasn’t uttered until the late 1970s and its use, like the symptoms that accompany it, has spiked dramatically, so much so, that it’s a household word (at least for women experiencing this hormonal upheaval and the people who love them).
When I first wrote this post in 2019, the problem was often dismissal: “Sorry, Lady, this is what happens when you get older.”
Today, “perimenopause” is everywhere: books, podcasts, your social feed. Hormone therapy is back on the table and in late 2025, the FDA moved to remove the black box warning about estrogen HRT. (Is HRT a game of chutes and ladders? Here’s my non-medical opinion on the matter.)
I believe this has created a new problem. Too often, every symptom gets pinned on perimenopause and women are handed an estrogen patch without anyone looking at their thyroid. It’s the same blind spot, just a few years further down the road.
First Things First
When no single symptom feels “bad enough” to warrant seeing a doctor, women can suffer needlessly. Because taken collectively (a little of this, a little of that), it can point to hypothyroidism—a problem that can certainly be addressed, helping you feel like yourself again, whether you’re in perimenopause or not.
But yes, the two often arrive together because thyroid dysfunction becomes more common in women at exactly this stage.
Sure, all women begin to see systemic shifts in their reproductive hormones (progesterone and estrogen) after the age of 35 or so. But we weren’t meant to live with life-altering symptoms day in day out, month after month. Or for some, year after year. In fact, many experts in the functional medicine community say that a woman’s thyroid, adrenal, and hydration status has everything to do with how she moves through this time of life.
Also keep in mind that perimenopause isn’t a gentle decline. Progesterone drops first as ovulation becomes erratic. Estrogen swings, sometimes more so than ever, before it finally falls. And a thyroid that’s already struggling makes those swings harder to ride.
The nice thing is that for many, they treat the hypothyroidism and see improvement across the board, including a completely renewed zest for life. Even subclinical low thyroid function (pre-symptomatic, elevated TSH with only slightly low Free T3 and Free T4) can riddle our pre-menopausal years with symptoms that get blamed exclusively on perimenopause.
What is the Thyroid?
The thyroid is a butterfly-shaped gland in our neck and it’s a tiny yet mighty player in our endocrine (hormonal) symphony. Many experts refer to it as “the master gland of metabolism” and I’ve often referred to it as the spoon that stirs our hormonal soup.
Every cell in our body has receptors for thyroid hormone—so it’s easy to understand how even subclinical low thyroid function can have an effect on so many of our body’s systems, such as steroid hormone production, glucose metabolism, body temperature regulation, energy, and reproductive hormones (the ones that start naturally declining after the age of 35).
Go here for my post, What’s Your Thyroid Telling You? >
Don’t Guess, Test
It can be challenging to sort this out with symptoms alone, which is why testing is important. If you’re symptomatic—even mildly symptomatic—and feel that you’re not quite yourself, I’d suggest getting a full thyroid panel, stat. Some of you may be reading this, thinking, “But my doctor tested my TSH (thyroid stimulating hormone) and said that I’m fine—I don’t have a thyroid problem.”
Please know that TSH tells a very small part of the story. It should always be considered in the context of Free T3 and Free T4 to discern what’s really going on because yes, can absolutely have “normal” TSH and still be hypothyroid.
Additionally, it’s estimated that 30 million women alone have Hashimoto’s (autoimmune hypothyroidism), which is the most common form of thyroid dysfunction. Therefore, in addition to a full thyroid panel, it’s critical to also test for thyroid antibodies, TPOAb and TgAb.
Here’s my suggested thyroid panel, including functional reference ranges >
Below are three things I’ve added to this list since this post was initially published:
- Heavy perimenopausal periods drain iron stores. Low ferritin causes fatigue and hair shedding on its own and your thyroid needs both iron and ferritin.
- Stop biotin before your blood draw. It’s in most hair, skin, and nail supplements and many multivitamins and it can skew thyroid lab results.
- Retest if you start hormone therapy. Oral estrogen raises the protein that binds thyroid hormone, which can leave less of it available. If you’re on thyroid medication, your dose may need to change. Have your labs rechecked about six to twelve weeks after starting. Estrogen through the skin (a patch or gel) has much less of this effect.
I also recommend doing a DUTCH (dried urine testing for comprensive hormones) panel. You can reach out if interested in this testing.
Ground Zero: Thyroid Nutrition
Some reading this may have already been diagnosed with hypothyroidism or Hashimoto’s. Some may be on thyroid hormone replacement and some not. Regardless, the thyroid is extremely nutrient dependent and being mindful of your diet is critical for managing hypothyroidism and Hashimoto’s—which in turn, can help women glide through “the change” (and those pre-change years) as unscathed as possible.
Remember, many functional medicine experts claim that a woman’s thyroid, adrenal, and hydration status has everything to do with how she moves through her pre-menopausal years.
I’ve seen it over and over, time and time again—women even with clearly defined perimenopausal symptoms like hot flashes and night sweats see their symptoms disappear or greatly diminish simply by focusing on their thyroid and adrenal health and drinking enough water. (Reach out for more information on what I feel is the single best hydration system in the world.)
Eating minimally processed foods that naturally contain supportive vitamins, minerals, and phytonutrients is, hands down, one of the best ways to support the thyroid, immune system, and entire endocrine system.
I spent many hair-splitting weeks nerding out on the ultimate thyroid and immune nutrition and foods rich in those nutrients. This nitty gritty research and data got transformed into the nutritional springboard for our #1 best selling cookbook, The Essential Thyroid Cookbook.
All of this research became the foundation upon which this first-of-its-kind resource was built, leaving no doubt in our readers’ minds that the recipes are uniquely beneficial to your thyroid and immune system. The recipes will support you for a lifetime of peak thyroid function no matter where you are on your wellness journey—and for those of us in those “pausal” years, help us get through this time of life the way that nature intended us to: calmly and peacefully, with vim and vigor.
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