You’ve turned 50 and life is changing, in many ways for the better. But you’re also more tired than usual, and you’re having trouble sleeping. Your moods are unpredictable and your thinking feels hazy. Your skin is drier, your hair is becoming coarser, and to top it all off, your menstrual cycle is less regular and your sex drive is nil. Is this menopause?

 

Because many of the symptoms of perimenopause (the period of time leading up to a woman’s final menstrual period) and hypothyroidism overlap, the American Association of Clinical Endocrinologists (AACE) is concerned that many women being treated for perimenopausal symptoms may actually have undiagnosed hypothyroidism.

Why the Confusion?

There are several reasons why symptoms of hypothyroidism might be identified as symptoms of menopause:

• There is a great deal of overlap between the symptoms of hypothyroidism and those of perimenopause
• Perimenopause and hypothyroidism often occur in women of very similar age ranges:
  • Perimenopause may begin as early as 35 or 40; symptoms can last up until menopause at 45-50
  • Hypothyroidism affects one out of eight women 35-65 years old, and one out of five women over the age of 65
• The symptoms of hypothyroidism may become more pronounced due to the hormonal changes occurring during perimenopause

Furthermore, undiagnosed thyroid problems are a common problem; some experts estimate that as many as 15 million Americans have undiagnosed thyroid disease. Not all of these individuals have symptoms or will necessarily require treatment, but none has been appropriately diagnosed with blood screening. In comparison to men, women are significantly more likely to have thyroid problems. And since the risk of developing thyroid disease increases with increasing age, elderly women have a particularly high risk for such disorders. The majority of post-menopausal women with thyroid disorders will have either no or very subtle symptoms and suffer from a condition known as subclinical thyroid disease. The majority of these women will have an underactive thyroid condition (hypothyroidism).

Is Treating Hypothyroidism Important?

This is a point of some controversy. Some researchers believe that hypothyroidism, particularly when it is subclinical (not dramatically impacting a woman’s quality of life), should be carefully monitored, but not necessarily treated. This was the conclusion of a study conducted by Jaeschke et al in 1996. In this study, the researchers evaluated a variety of quality-of-life and blood lipid parameters in 37 women with subclinical hypothyroidism who were randomly assigned to receive either placebo or thyroid replacement therapy. According to Jaeschke et al, the group receiving thyroid replacement showed no significant clinical improvement in quality of life or serum lipid parameters, when compared to the group receiving only placebo.

On the other hand, there are those that believe not treating subclinical hypothyroidism increases a woman’s risk of several serious complications, including decreased heart function, increased risk of blood vessel disease, and heart attack . For example, in 2000, Hak et al evaluated 1,149 postmenopausal women, to determine if there was a relationship between subclinical hypothyroidism and aortic atherosclerosis and myocardial infarction (heart attack) in postmenopausal women. The study concluded that subclinical hypothyroidism is indeed a strong indicator of risk for atherosclerosis and myocardial infarction in elderly women. A brief but comprehensive review of this topic by Dr. Annamarie Ibay and colleagues concluded that there is as yet insufficient evidence to justify treating most adults with subclinical hypothyroidism.

The Bottom Line

If you are experiencing symptoms of hypothyroidism—such as fatigue, memory loss, depression , problems with thinking—talk with your healthcare provider so the two of you can determine whether further testing is needed. If so, this usually requires no more than a simple blood test to measure the level of a substance called thyroid stimulating hormone (TSH). When the thyroid is underactive, the levels of TSH in the blood increase in an attempt to stimulate the thyroid to be more active.

If you are found to have hypothyroidism, rest assured that treatment for hypothyroidism is also relatively simple and generally very effective. A synthetic thyroid hormone called levothyroxine (Synthroid, Levothroid) can be given orally, usually resulting in complete resolution of symptoms.

RESOURCES:

American Association of Clinical Endocrinologists
http://www.aace.com

Facts About Thyroid Disease American Medical Women’s Association
http://www.amwa-doc.org

Thyroid Disorders US Department of Health and Human Services, Office on Women’s Health
http://www.4women.gov

References:

Hak AE et al. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: The Rotterdam Study. Ann Intern Med. 2000;132:270-278.

Ibay AD, Bascelli LM, Nashelsky J. Management of subclinical hypothyroidism. Am Fam Physician . 2005;71(9):1763-4. Available at: http://www.aafp.org/afp/20050501/fpin.html . Accessed August 8, 2005.

Jaeschke R, Guyatt G, Gerstein H, et al. Does treatment with L-thyroxine influence health status in middle-aged and older adults with subclinical hypothyroidism? J Gen Intern Med. 1996;11:744-749.

Meier C. TSH-controlled L-thyroxine therapy reduces cholesterol levels and clinical symptoms in subclinical hypothyroidism. J Clin Endocrinol Metab. 2001;86:4860-4866.

Monzani F, Bello VD, Caraccio N, et al. Effect of levothyroxine on cardiac function and structure in sublinical hypothyroidism: a double blind placebo-controlled study. J Clin Endocrinol Metab. 2001;86:1110-1115.

Morocco M, Kloss RT. Subclinical hypothyroidism in women: Who to treat. Disease-A-Month. 48:659-70.

Schindler AE. Thyroid function and postmenopause. Gynecol Endocrinol . 2003;17:79-85.

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