Thyroid or Perimenopause?

Kelly Anne Spratt, D.O., Director of Women's Cardiovascular Health at the University of Pennsylvania Presbyterian Medical Center, answers your questions.


Q. I am a 37-year-old woman. During the last year, I have had a decreased energy level, increase in weight, and an excessive amount of sweating, and I've been somewhat depressed. My mother told me to have my thyroid checked and my doctor said it was normal. He checked it in the middle of the day; my mother (who has thyroid problems) said her doctor had her fast the night before to get an accurate reading. Which is correct or does it matter? Should I return to the doctor and check for something else? I had a hysterectomy (still have my ovaries) over a year ago. The sweating is quite embarrassing. My hair will get wet and drip down my face. Any help would be appreciated.

A. For some tests such as cholesterol or glucose, it is important to fast overnight, but this is not the case with thyroid testing. Your symptoms sound as if you may be perimenopausal. Although you do have your ovaries intact, some women actually have a decrease in estrogen levels with simple hysterectomy. It is becoming more apparent that the uterus also is involved in estrogen production and some women do experience menopausal symptoms due to a relative deficiency of estrogen.

Two options include a blood test to see where your estrogen level is at this point, and/or a trial of a very low dose of supplemental estrogen -- for example, half of the usual starting dose of estrogen that would be given to a postmenopausal woman. Do you have other perimenopausal symptoms such as vaginal dryness, sleep disorders, or hot flashes? Go back to the doctor and continue to look for a correct diagnosis.

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