By age 40, almost 65% of women report experiencing moderate or severe symptoms associated with perimenopause.1 As Sarah Block, DNP, an SSM Health Women’s Health provider explained, “Since we have estrogen receptors in every body system, the symptoms vary widely. This can make diagnosing perimenopause a little tricky.”
Still, issues like weight gain and fatigue can also result from hypothyroidism – an underactive thyroid. This affects up to 10% of women in their 40s.2 And to complicate matters, it often develops during the same perimenopausal timeframe. Understanding the differences and knowing when to seek help is important.
Identifying perimenopause vs thyroid symptoms
Although the two share many symptoms, some are condition-specific. Knowing which you have can help determine whether your body is going through a natural change, or if your thyroid is acting abnormally.
| Shared symptoms | Brain fog, dry skin, fatigue, hair loss, heat intolerance, menstrual changes, mood swings, muscle/joint pain, weight gain |
| Perimenopause only symptoms | Hot flashes, increased anxiety, night sweats, racing heart, sleep disorders, vaginal dryness |
| Thyroid only symptoms | Cold intolerance, constipation, brittle hair and nails, slowed heart rate |
It’s important to note that you can have both issues. According to Block, “Since a dysfunctional thyroid can present with similar symptoms, it is recommended that the thyroid-stimulating hormone level be checked to help differentiate. There are no lab tests that will diagnose perimenopause or aid in the prescribing of hormone therapy.”
When to seek help
If you’re experiencing the thyroid-specific symptoms, reach out to your provider to request TSH, T3, and T4 blood tests to confirm a diagnosis. But with mixed or menopause-specific symptoms, Block recommends seeking help when they become bothersome or affect quality of life. “We base treatment on symptoms, but hormone therapy is treating the root cause: decreased production by the ovaries. Every woman has a different sensitivity to hormones and treatments are customized to each patient.”
She added, “For so long we were so hesitant to prescribe hormone therapy after the Women’s Health Initiative study showed it caused breast cancer. Many women suffered through the menopause transition. That portion of the study has been disproven. We now know there is no increased risk of breast cancer initially and only a 0.4% increased risk after five years.” Block believes the benefits of a better quality of life outweighs that very small risk.
Find the answers you need
If you’re concerned about any symptoms you may be experiencing, find an SSM Health Women’s Health provider for diagnosis and treatment.
- Perimenopause symptoms, severity, and healthcare seeking in women in the US, NPJ Women’s Health, February 25, 2025, https://www.nature.com/articles/s44294-025-00061-3
- Frequency of Thyroid Disorder in Pre- and Postmenopausal Women and Its Association With Menopausal Symptoms, Cureas, June 24, 2023, https://pmc.ncbi.nlm.nih.gov/articles/PMC10365143/
