A 48-year old woman came into my office a few months ago. She was complaining of fatigue and a sense of depression. In addition, she was concerned that her weight had begun to "shift" to her middle and her desire for sex had become negligible. Her periods were irregular and infrequent. I saw her and attributed her symptoms to menopause. We discussed the pros and cons of hormone replacement therapy and she elected to try it. We also discussed the benefits of calcium supplementation.
The patient returned for a follow-up visit a few weeks ago. Although she had no problems with the hormone replacement and had started taking the calcium supplementation, she was still feeling fatigued and depressed. Based on her symptoms and physical exam, I ordered a few tests, including a thyroid screen (TSH). The results came back showing she had hypothyroidism.
The term "hormone replacement therapy" or HRT, refers to hormones such as estrogen, testosterone, and progesterone that are taken daily to stabilize and increase a menopausal woman's hormone levels. It's good to know all the options that are available, from pills to patches, creams, and vaginal rings. Your doctor can explain them.
According to the American Association of Clinical Endocrinologists (AACE), millions of women with unresolved menopausal-like symptoms, even those taking estrogen, may be suffering from undiagnosed thyroid disease. While symptoms such as fatigue, depression, mood swings, and sleep disturbances are frequently associated with menopause, they may also be signs of hypothyroidism. A survey done by the AACE showed that only one in four women who have discussed menopause and its symptoms with a doctor were also tested for thyroid disease. The thyroid plays a role in regulating overall body metabolism and influences the heart, brain, kidney, and reproductive system, along with muscle strength and appetite.
The case presented above illustrates how the symptoms of hypothyroidism can be attributed to menopause. While the issue of menopause needs to be addressed, it is also important to remember that the incidence of hypothyroidism increases with aging and can co-exist with other conditions.
As patients, you should be aware of the signs and symptoms of hypothyroidism and let your doctor know if you have concerns about your thyroid function. If you are a woman experiencing symptoms of menopause, do not hesitate to discuss them with your doctor. If you feel that the symptoms are persisting despite appropriate therapy, it may be worthwhile to have your TSH checked. A blood sample is all that is needed to make the initial diagnosis of hypothyroidism and treatment is easily achieved with thyroid replacement therapy. Remember that a simple blood test may be the key to improving your quality of life in the menopausal stage and for years to come!