The Overlap: Distinguishing Perimenopause Pain from Thyroid Fatigue

Guessing Game: Perimenopause vs. Hypothyroidism

Another week of "let’s guess which symptom is caused by what problem" has left me exhausted. With so many things between perimenopause and Hashimoto's/hypothyroidism overlapping, it’s often impossible to work out the root cause. However, I have learned a subtle but crucial trick for identifying the dominant crash:

• Perimenopause Fatigue: This is tiredness I can generally cope with, but my eyes feel like they are bouncing around, like those bogly eye glasses.

• Thyroid Fatigue: This is bone-deep exhaustion—I cannot keep my eyes open, I'm freezing to the bone when everyone else is shedding clothes, and I can't stay warm.

I know being on HRT can change thyroid levels, so I’m trying to get the dose right for perimenopause so I can get back to working on my thyroid, which I certainly know is struggling.

The Collision: Crisis Point and Early Period

This week, the symptoms of both sides hit hard:

• Perimenopause: The characteristic hip, joint, and muscle pain returned, compounded by the feeling that my ligaments are bruised. To top it off, I got my period three weeks early, disrupting the six-week cycle I’d finally established.

• Thyroid: Extreme tiredness, cold to the bone, and being unable to stay warm. The fatigue led to me being asleep by 8 PM, so deeply that I missed my thyroid night tablet—a setback I now have to manage.

The intensity of the crash meant asking for help. My husband had to do the chickens for a few extra afternoons, and as we were putting the big and small chickens together, I had to annoy my teen and ask him to help his dad on Monday night, as my body just didn’t want to move. Walking to the kitchen wasn't even doable. Sometimes things just go wrong, and you can’t fight it.

The High-Stakes Adjustment: Four Pumps and Extra T4

By Wednesday, I decided I couldn’t handle the pain and extreme cold anymore. I took drastic, self-directed action.

This sudden disruption and return of bone-deep cold immediately made me suspect both hormones were out of whack. I know that as estrogen levels rise, they can increase the body's requirement for thyroid medication (T4), and my recent HRT increase was likely dragging my thyroid levels down with it. Waiting six weeks for a doctor was simply not an option for dealing with this combined crash.

My self-directed action was:

• HRT Increase: I moved up to four pumps of Estrogen Gel.

• Thyroid Adjustment: On Tuesday night, I took an extra T4 tablet.

By Wednesday afternoon, the immediate change was undeniable. I was feeling a lot better—still sore, but dramatically improved. I wasn't freezing, and the constant pain was easing. That morning, homeschooling was times tables, and my son did the baking 90% on his own. I managed to get the floor vacuumed, then had a few hours of rest (more than I should have) before washing all three dogs that afternoon (I think they had been rolling in something dead they found).

I also managed to clean out the outside house for the youngest chicks to move into next week—a small, but important win.

The Payoff: Small Victories and Sustainable Energy

I felt pretty darn good right through Friday. I managed my morning in town and the jobs I had to do at home with the only symptom really being tiredness by mid-afternoon with mild hip pain. This sustained stability is the goal.

The youngest chickens also went outside this week and are loving the increased room, grass, and bugs.

Even though my gardening focus led to a mistake (waiting too long meant all my seedlings curled up and died), I went to Mitre 10 on Friday and replaced them. Next year, I know I need to wait until October to plant seeds so they aren’t so big before I can plant outside. This is progress—learning through doing.

 Practical Tips for Managing a Symptom Flare-Up

When you are dealing with two conditions like Perimenopause and Hashimoto's, a symptom crash requires a triage strategy. Here are my tips for managing when things get this bad:

1. Stop Guessing and Triage: Don't waste energy trying to pinpoint the exact cause of a severe crash. Treat the most debilitating symptom first. If you are freezing and exhausted (thyroid), prioritize warmth and sleep. If you are in severe joint pain (perimenopause), prioritize rest and pain relief.

2. Protect the Sleep Window: If you are so exhausted you are falling asleep before your night medication, set an alarm two hours earlier to take it, or delegate the evening routine to your partner. Missed medication is a guaranteed setback.

3. Use the "Just Enough" Rule: When you feel a brief surge of relief (like I did on Wednesday), don't tackle a major project. Use that energy for a small, critical win (like vacuuming the floor or cleaning the chick house), and then stop immediately to protect the rest of the day.

4. Know Your Non-Negotiables: Accepting that the house will suffer is crucial. Prioritize life-sustaining tasks over housekeeping. For me, that means making sure the chickens are fed, the dogs are clean, and the kids are fed, even if the vacuuming becomes a "distant memory."

5. Adjust, Don't Suffer: If you have a long, clear history with your medication (like HRT or thyroid), and access to a doctor is a six-week wait, trust your body's signal for a slight adjustment if you have a follow-up scheduled. (Always proceed with caution and inform your doctor at your next appointment).

    

   Have you experienced the strange side effect of zero appetite while on HRT, or found your joint pain returning when you ignore your body's need for rest? Share your experience below.