Menopause is a rite of passage for all women if we live long enough. Some women breeze right through while others experience debilitating hot flashes, weight gain, insomnia, moodiness and joint aches. Many studies have found that around 50 percent of women find themselves in the latter category. What can be very confusing is that, along with the ovaries pooping out, sometimes the thyroid goes as well.

The incidence of hypothyroidism is between 30 and 40 percent in menopausal women. Common symptoms are fatigue, weight gain, poor sleep, depression, weakness, joint aches, brain fog, hair loss, dry skin, cold hands and feet, hot flashes and poor libido. Common symptoms of menopause are joint aches, weight gain, poor sleep, hair loss, vaginal dryness, hot flashes and loss of libido. When women complain of any of the above symptoms, they are often told it is menopause and not evaluated for a thyroid issue — which isn’t surprising considering that many of the symptoms are the same.

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That’s why it is important to know the difference. There are a few telltale signs of hypothyroidism that are not something we see in menopause. For example, it’s quite common for women to lose the outside of their eyebrows, and the area under the eyes can become very puffy. Constipation also occurs frequently in hypothyroidism and is not usually seen as a symptom of menopause.

What causes hypothyroidism or low thyroid? Hashimoto’s thyroiditis is a common cause of this condition. It is a disease in which the body’s own antibodies attack the thyroid. It occurs more often in women as we age. There are certain medications such as Amiodorone (a heart medication) that can cause hypothyroidism. Radiation for head and neck cancers can affect the thyroid gland, and low iodine levels can also cause the thyroid to slow down.

The best way to know if you have hypothyroidism is to get a blood test. I usually test the TSH (thyroid stimulating hormone), Free T3 and Free T4 (thyroid hormones). An elevated TSH is an indicator of hypothyroidism. The free T4 is converted to T3 (the active hormone) in the body. Sometimes people have a problem converting from T4 to T3. If this is the case, the T4 will be normal and the T3 will be low. Those patients need to be treated a little bit differently.

If the cause of low thyroid is due to a low iodine level (tested by collecting a 24-hour urine sample for iodine), then the best way to fix it is by eating iodine-rich foods, such as shell fish and kelp.

If Hashimoto’s thyroiditis is the problem, the best approach is a healthy, non-inflammatory diet that is rich in lean protein, vegetables, fruits and whole grains and the avoidance of processed foods.

Regardless of the cause, if the thyroid is not functioning properly, medication may be necessary. The synthetic thyroid hormone known as Synthroid or Levothyroxine is the treatment most often prescribed. For many, this treatment is adequate. However, for those of us who do not convert T4 to T3 (I am one of them), it is important to add T3. This can be done by adding l-thyronine (synthetic T3) to the medical regimen or prescribing Armour thyroid. Armour thyroid is dried pig thyroid and contains both T3 and T4.

The bottom line is that if you are a menopausal woman who is gaining weight, feeling tired, achy and miserable, get your thyroid checked. There is a pretty good chance you have hypothyroidism. If that is the case, once treated, you will feel much better. 

Robin Miller, MD, is a practicing integrative medicine physician at Triune Integrative Medicine in Medford, Oregon. She is a medical reporter for KOBI-5 NBC and has appeared on "The Doctor Oz Show." She is co-author of "The Smart Woman's Guide to Midlife and Beyond."

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