Hypothyroidism in Women: 10 Signs and Symptoms to Know

Do you have thinning hair, fatigue, or symptoms of depression? It’s easy to write off these symptoms as being related to stress or hormone changes linked to menopause. But these common symptoms could also all be due to an underactive thyroid, a condition called hypothyroidism.

Your thyroid is a small but very important gland located at the front of your neck. It produces two hormones — T3 (triiodothyronine) and T4 (thyroxine) — that travel throughout your body. These hormones help make sure all your systems are working properly. Thyroid hormones help to regulate your weight, metabolism, reproduction, and brain development. 

In hypothyroidism, the thyroid gland isn’t producing enough thyroid hormone. It’s pretty common — up to 5% of the population has this diagnosis (and it probably goes undiagnosed in even more people). It’s also up to 10 times more common in women than in men. Low thyroid hormone levels can result in many different types of symptoms. 

Signs and symptoms of hypothyroidism in women

Hypothyroidism can lead to a range of symptoms. Here are 10 of the most common symptoms of hypothyroidism in women.

1. Irregular periods

The female reproductive system depends on thyroid hormones. That’s why hypothyroidism can affect menstrual cycles. One study showed that more than 2 in 10 women with hypothyroidism had some type of irregular period — either heavy periods or infrequent ones.

Not surprisingly, more severe hypothyroidism was associated with more irregular periods. Hypothyroidism can also lead to not having any periods at all (called amenorrhea). 

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2. Weight gain

Weight gain is a common and frustrating symptom of hypothyroidism. Usually people gain 5 lbs to 10 lbs. But some report an average of a 10% increase in body weight. While most of the weight is from retaining more salt and water, some is from increased fat. 

Why does this happen? The thyroid helps control your metabolism and regulate appetite. When thyroid hormones are low, your metabolism slows down, which means you burn less energy. And weight can start to increase when you’re less active because you’re tired.

Treating hypothyroidism can help stop weight gain. But this doesn’t mean you’ll lose the extra weight. To do that, you may need some other tools, including a nutritious diet, exercise, and sometimes medication.

3. Tiredness and feeling cold

Tiredness (fatigue) and feeling cold are common signs of an underactive thyroid. These symptoms also seem to get worse as hypothyroidism worsens.

When your thyroid hormone levels are low, your energy levels decrease, and your metabolism slows down. This results in feeling tired and cold. 

4. Hair loss

Hair loss can affect about 1 in 3 people with hypothyroidism. This ranges from mild thinning to very extensive hair loss. Some people may even experience loss of their outer eyebrows (madarosis).

Other common hair changes in hypothyroidism include dry, brittle, and coarse hair that may take longer to grow. Similar changes can happen to nails — they can also be brittle and thick, and they may grow more slowly. 

Individual hair follicles have a very regular growth cycle. And hypothyroidism may negatively affect how hair starts growing and the length of hair growth. Proper hair-loss treatment can reverse these changes.

5. Dry skin and other skin changes

Dry skin is one of the most common symptoms of hypothyroidism. With less thyroid hormone, the skin becomes thinner and more scaly because of dead skin cells — resulting in dry skin. Dry skin is more likely to affect the skin on the arms and legs above the joints. But it can involve the palms and soles too.

Myxedema is a serious complication of untreated hypothyroidism. It can cause skin changes. In myxedema, the skin (especially on the face, hands, and feet) gets swollen because fluid builds up in the skin. This is a medical emergency and among the thyroid-related complications that needs medical attention.

Treatment can reverse skin changes due to hypothyroidism. But it can take some time for your skin to improve after your thyroid hormone levels have returned to normal.

6. Infertility and subfertility

Difficulties becoming pregnant may point to a thyroid issue. Thyroid hormones are involved in reproduction, and low levels can contribute to infertility.

Hypothyroidism can affect fertility in several ways, including:

• Preventing normal ovulation (the release of the egg in menstruation)

• Causing irregular menstrual cycles

• Increasing the risk of miscarriage

Proper treatment can reverse many of these effects. One study found that most women who had difficulty conceiving got pregnant within 1 year of starting thyroid treatment. Even mild hypothyroidism (without any obvious symptoms) can interfere with normal reproduction. So it’s common for your healthcare team to check your thyroid levels if you’re trying to conceive.

Hypothyroidism in pregnancy can lead to complications for both the mother and baby. This includes: 

• Gestational hypertension and postpartum hemorrhage in the mother

• Low birth weight and respiratory distress in the newborn

7. Sexual dysfunction

Sexual dysfunction refers to any problem that affects your desire for or enjoyment of sex. And it can be hard to talk about, especially for women. If you experience sexual dysfunction, it might be because of an underactive thyroid.

Nearly half of women with hypothyroidism may experience some type of sexual dysfunction. This can range from problems with desire and arousal to difficulties with orgasm. 

It’s unclear exactly how hypothyroidism leads to sexual dysfunction. But it may affect sex hormone levels, which then alter sexual function. The good news is that thyroid-related sexual dysfunction is reversible with treatment, though it may take some time.

8. Depression and mood changes

Sometimes, hypothyroidism causes depression and other mood disorders, including anxiety. People with hypothyroidism are up to 2.5 times more likely to develop depression. And this is pretty common — especially in women. In general, women are more likely than men to experience depression and anxiety.

People with hypothyroidism can also show other mental changes, like: 

• Difficulty concentrating

• Poor memory

• Slowed thinking

But experts don’t know exactly why they’re linked. Some researchers suggest that hypothyroidism can cause metabolic changes in the brain. This may also affect levels of certain neurotransmitters (chemical messengers in the brain) that are linked to depression. 

9. Constipation

Low thyroid levels can slow down your metabolism. So, it’s not a big surprise that hypothyroidism can also slow down your gut and cause constipation. 

Constipation isn’t one of the most common symptoms. Some estimates show that about 2 in 10 people with hypothyroidism report experiencing constipation.

But constipation might be the only symptom of hypothyroidism for some people. So, if your constipation is new and nothing else seems to be causing it, checking your thyroid levels could be a good idea. 

10. Muscle weakness and cramps

Weak muscles or muscle cramps are common in about half to three-quarters of people with hypothyroidism. Muscles need thyroid hormones to work well. And low thyroid hormone levels can affect how the muscles function.

In hypothyroidism, muscle weakness is most likely to affect the upper arms and upper legs. Keep in mind that, sometimes, weakness and cramps can be the main (or only) symptoms of hypothyroidism. 

Why are women more likely to have hypothyroidism?

Women are more likely to have hypothyroidism than men. But scientists don’t fully understand why. Women have higher rates of autoimmune conditions, and hypothyroidism is often autoimmune. Also, women are more likely to develop thyroid problems around pregnancy or menopause. So hormone changes likely play a role. 

What are common causes of hypothyroidism in women?

Hypothyroidism has many different causes. In the U.S., the most common reason is Hashimoto’s thyroiditis, an autoimmune disorder. In this condition, your immune cells attack your thyroid gland and prevent it from doing its job.

Around the world, the most common cause of hypothyroidism is too little iodine in the diet. This is important, since the thyroid gland needs iodine to work properly. Other, less common causes of hypothyroidism include: 

• Previous thyroid surgery

• Radiation treatment

• Cancer

• Certain medications, like amiodarone and lithium

When should you go to the doctor’s office?

Head to your doctor’s office if you have any new symptoms affecting your health. Hypothyroidism can have symptoms that look like other conditions. So, it’s best to connect with a medical professional. 

Hypothyroidism symptoms can easily be dismissed or confused for other conditions, such as medication side effects, anxiety or depression, or hormone changes related to menopause. Because of this, it’s important to make sure you feel heard and to ask about your thyroid health and thyroid testing.

You should also contact your healthcare team if you know you have hypothyroidism and you’re experiencing symptoms. People often need to adjust their hypothyroidism treatment throughout their lifetime. This can be due to lab results or symptoms. If you’re taking treatment and your symptoms are ongoing, let your care team know.

If hypothyroidism is left untreated, it can lead to more serious complications. Later symptoms and health problems that can develop with hypothyroidism include: 

• Elevated cholesterol and increased heart disease risk

• Nerve damage

• Puffiness of the face, hands, and feet (myxedema)

• Low body temperature

• Low heart rate

• Memory issues

Myxedema coma is a rare but dangerous and life-threatening risk of untreated hypothyroidism. It causes extreme lethargy and weakness and can lead to respiratory failure and death. It’s a medical emergency that needs immediate hospitalization and treatment.

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Written by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

Edited by:

Alex Eastman, PhD, RN

Alex Eastman, PhD, RN, is a California-based registered nurse and staff medical editor at GoodRx, where he focuses on clinical updates and Latino health.

Reviewed by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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