12th August 2026
Is It Menopause or Thyroid Disease? Understanding Hashimoto's Thyroiditis
Feeling exhausted, struggling with weight changes, sleeping poorly or noticing shifts in mood and libido can feel like an expected part of midlife. For many women in their 40s and 50s, these symptoms are often linked to perimenopause or menopause.
But menopause is not always the only explanation. In some cases, the thyroid may also be playing a role. An underactive thyroid can cause many of the same symptoms, and one of the most common causes is an autoimmune condition called Hashimoto’s thyroiditis.
Is It Menopause or Your Thyroid? Why the confusion happens
The confusion is understandable because menopause and thyroid disease can affect women at a similar stage of life. Hashimoto’s thyroiditis is more common in women than men, and often develops between the ages of 30 and 60. Menopause usually occurs between the ages of 45 and 55, which means that the two can easily be considered at the same time.
The symptoms can also be very similar. Both can affect energy levels, cause weight gain, changes in mood, sleep disturbances and reduced. This overlap can make it difficult to know whether symptoms are hormonal, thyroid-related or a combination of both.
For women who feel that something is not quite right, it is worth looking beyond the assumption that symptoms are simply “part of getting older”. A thyroid check can help identify whether an underactive thyroid may be contributing to how they feel.
Symptoms that may point more specifically to your thyroid
While there is overlap, some symptoms may suggest that the thyroid should be investigated.
An underactive thyroid can slow down the body’s metabolism. This may lead to:
- Ongoing tiredness or low energy
- Feeling unusually sensitive to cold
- Chronic constipation
- Weight gain
- Slower movement or speech
- Slow heart rate
- Shortness of breath on physical exertion
- Dry or coarse skin and hair
- Puffiness in the face
- Hoarseness of the voice
- Swelling in of the legs
- Heavy or more frequent periods in pre-menopausal women
By contrast, symptoms such as hot flushes, night sweats and vaginal dryness are more suggestive of menopause. It is also important to remember that not everyone with thyroid changes will have obvious symptoms, especially in the earlier stages. Some people may have what is known as subclinical hypothyroidism, where blood tests show early thyroid changes, but symptoms may be absent or very mild. Subclinical thyroid disease.
What is Hashimoto’s thyroiditis?
Hashimoto’s thyroiditis is an autoimmune condition. This means the immune system mistakenly attacks the body’s own thyroid gland. Over time, this can damage thyroid cells and reduce the gland’s ability to produce thyroid hormones. The thyroid gland plays an important role in controlling the body’s metabolism. When thyroid hormone levels are too low, many body processes can slow down. This is known as hypothyroidism, or an underactive thyroid. Hashimoto’s thyroiditis is the most common cause of chronic hypothyroidism in iodine-sufficient countries, including Ireland. It is usually slow, long-term and progressive, which means it can develop gradually over many years. There are forms of Hashimoto’s thyroiditis, goitrous and atrophic both can lead to the same underlying problem: reduced thyroid function.
Why does it happen more often in women?
Hashimoto’s thyroiditis, like most other autoimmune diseases affects women much more often than men.
Women are estimated to be affected around five to ten times more frequently.
The reason for this is multifactorial and involves female sex hormones and the X chromosome. Risk factors for Hashimoto’s thyroiditis include:
- A personal or family history of another autoimmune condition
- Pregnancy Excess iodine exposure
- Exposure to radiation in people who are already at risk
- Because Hashimoto’s can be slow to progress, it may not cause symptoms for many years.
This can make it harder to recognise, especially when symptoms appear around the same time as perimenopause or menopause.
How is Hashimoto’s diagnosed?
Diagnosis usually begins with blood tests. These are:
- TSH (thyroid-stimulating hormone)
- Free T4 (one of the main thyroid hormones)
- Thyroid antibodies, particularly thyroid peroxidase antibodies, also known as TPO antibodies
A high TSH with a low free T4 level suggests an underactive thyroid. TPO antibodies can support a diagnosis of Hashimoto’s thyroiditis, as they show evidence of an autoimmune process affecting the thyroid Underactive thyroid (hypothyroidism) overview. In some cases, a thyroid ultrasound may also be carried out, particularly if there is swelling in the neck or a goitre.
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Can you test at home?
Home thyroid testing kits are now more widely available and may identify abnormal thyroid blood results, such as a raised TSH or low T4. Some kits also test for TPO antibodies.
However, home testing should not replace medical assessment. Any abnormal result should be confirmed through medical laboratory testing arranged by a GP or endocrine clinic. A doctor can also take a full history, carry out a clinical examination, interpret results in context and decide whether treatment is needed.
What happens if Hashimoto’s is confirmed?
If Hashimoto’s thyroiditis is causing overt hypothyroidism, treatment usually involves replacing the deficient thyroid hormone with levothyroxine tablets.
Levothyroxine is usually taken once daily on an empty stomach. It is commonly advised to take it either 60 minutes before breakfast or at least four hours after dinner. Taking it consistently, and away from food, helps the body absorb the medication properly.
After starting treatment, thyroid function tests are usually repeated after six to eight weeks to check whether the dose needs adjusting. Once thyroid levels are stable, testing may be done annually, although more frequent monitoring may be needed if results or drug dose change or if there is a change in the person’s health status.
Symptoms may begin to improve within a couple of weeks of starting treatment, but full recovery can take several months.
When should you see a specialist?
Many thyroid concerns can begin with a GP appointment and blood tests. However, specialist input may be helpful when symptoms do not improve, results are difficult to interpret or treatment decisions are not straightforward.
You may benefit from seeing an endocrinologist if:
- Symptoms continue despite GP-level assessment or treatment
- Thyroid blood results are abnormal and need further interpretation
- There is possible subclinical hypothyroidism and it is unclear whether treatment is needed
- You have a goitre or swelling in the thyroid area
- You are pregnant, planning pregnancy or trying to conceive
- You have another autoimmune condition or a strong family history of thyroid disease
- You are unsure whether symptoms are related to menopause, thyroid disease or both
Mater Private Network’s Diabetes & Endocrinology service provides consultant-led assessment and treatment for endocrine conditions, including thyroid disorders. If you are experiencing symptoms that could be linked to your thyroid, or if you have abnormal thyroid blood results, our consultant endocrinologists can assess your symptoms, review your results and advise on the most appropriate next steps.
The above content was provided by Dr. Issam Hajjaji, Consultant Endocrinologist at Mater Private Network in Cork.
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