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Perimenopausal and postmenopausal women are at increased risk of thyroid disease.
There’s even a term called “thyropause”: it refers to hypothyroidism that’s triggered by the decline in ovarian hormones (that naturally happens during peri and menopause).
How do your ovarian hormones impact your thyroid?
Lower progesterone means reduced free or available thyroid hormone and can trigger the autoimmunity that is at the root of most cases of an under- or overactive thyroid. (The same happens postpartum when progesterone levels drop and can trigger thyroid autoimmune disorders).
Also estrogen levels have an impact on your thyroid: they can have an impact on low thyroid function, hypo or hyperthyroidism and even thyroid cancer - read more details here.
If you have too much estrogen circulating in your bloodstream, your liver will increase the production of thyroid-binding globulin (TBG). This is an inhibitor protein that binds to the thyroid hormone. It means that the amount of produced but inactive thyroid hormone (T4) is being reduced and therefore also leads to low active thyroid hormone (T3 levels because your body cannot convert the inactive T4 that’s bound up by the TGB). If high estrogen levels reduce the amount of T4 (and T3 because of TGB), your brain (hypothalamus and pituitary gland) will call up your thyroid to produce more thyroid stimulating hormone (TSH) to compensate.
This then results in symptoms of an underactive thyroid. It means that although there is not a direct issue with your thyroid gland, you’ll still experience symptoms of hypothyroidism.
Too much estrogen can also block the uptake of thyroid hormones, once again leading to symptoms of hypothyroidism.
These symptoms often manifest most strongly during perimenopause, when progesterone levels are significantly decreased but estrogen is still present. Remember that low progesterone levels in perimenopause will cause an imbalance with estrogen that results in estrogen excess compared to progesterone.
Estrogen is also responsible for stimulating the growth of the thyroid gland and the production of thyroglobulin, a thyroid hormone precursor.
High levels of thyroglobulin will cause the goiter which is the result of too much growth of the thyroid gland.
If your estrogen levels are too low on the other hand, it will cause low thyroglobulin, which reduces your thyroid function. Confusing right? Too much and too little estrogen will both end up making your thyroid under active but for different reasons....
How does cortisol impact your thyroid function?
There's another important hormone that's impacting your thyroid function and that's often elevated in perimenopause: cortisol. Hormone imbalance and stress during perimenopause can reduce healthy thyroid function.
As progesterone decreases with perimenopause, you may notice more stress than usual. This means your adrenal glands pump out more cortisol to help you cope. But prolonged periods of stress, which also mean prolonged high cortisol levels make it harder for your liver to clear excess estrogen, which is already an issue during perimenopause.
Adrenal stress, excess estrogen, and hormonal birth control can all increase levels of TBG and reduce thyroid function.
Now, there's another hormone that's triggering the release of cortisol: insulin! Women have an extra “handicap” when it comes to blood sugar regulation when your hormone levels decline or are simply imbalanced: you can become "insulin-resistant." This happens when your estrogen levels decline, because estrogen also is key to glucose utilization in the brain.
Insulin resistance can also trigger lower levels of sex hormone binding globulin (SHBG), the hormone that binds to excess estrogen and testosterone. Go back to my previous article on blood sugar in (peri)menopause.
Sometimes, it can be tricky to differentiate the symptoms of hypothyroidism, insulin resistance and (peri)menopause since they are usually similar. Whether you already have an established diagnosis of thyroid disease when you reach menopause or you develop it during this new period of your life, it can be tricky to actually understand which of the two is causing your symptoms as they’re pretty much overlapping.
Symptoms of hypothyroidism, insulin resistance & (peri)menopause:
moodiness
forgetfulness or brain fog
hair loss
depression
irregular menstrual cycles
weight gain or inability to lose weight
high cholesterol
fatigue
facial hair
On the other hand, hyperthyroidism (overactive thyroid) and (peri)menopause can also share some symptoms, such as:
fatigue
sleep disturbances
heart palpitations
heat intolerance
hot flashes
anxiety
How can you know if it’s perimenopause or your thyroid?
As I just said, thyroid disorders are common around the time of menopause, or just before, during perimenopause. But many women overlook their thyroid problems because the symptoms are so similar to menopause and it seems like they’re “normal” for that age.
7 Thyroid and perimenopause symptoms to look out for:
Changes in menstruation: Perimenopause is usually associated with irregular periods, heavy periods, or missed periods altogether. Hyperthyroidism can also result in irregular menstrual cycles, and hypothyroidism may cause heavy bleeding, very light bleeding, and changes in the frequency of cycles.
Fatigue: One common side effect of perimenopause is reduced energy and feelings of fatigue. Hypothyroidism also causes symptoms of fatigue, in addition to poor concentration and brain fog. Hyperthyroidism can result in high energy, but it’s not generally an energy that makes you feel good. On the contrary, hyperthyroid can make you feel scattered or overly anxious.
Weight gain, especially around the belly: most women experience weight gain during perimenopause. Weight gain appears to be triggered mainly by estrogen levels that are higher than normal and progesterone levels that are too low. High estrogen causes weight gain via insulin resistance, which changes how your body responds to insulin, and increases fat storage especially around the belly. Hypothyroidism often causes weight gain, and hyperthyroidism usually leads to weight loss.
Digestive Problems: an underactive thyroid, or hypothyroidism, slows down your metabolism and often causes constipation, while an overactive thyroid on the other hand, frequently causes diarrhea. Go back to my previous article on how your hormones impact your gut health and vice versa to read more on digestive problems in perimenopause and menopause.
Sleep issues: During perimenopause, many women complain about waking again 3 to 4 hours after falling asleep and are then unable to go back to sleep. This can be due to much lower progesterone levels, which allows cortisol levels to rise slightly during the night when they should be low. This rise in cortisol will keep you awake. Hyperthyroidism typically causes insomnia, while hypothyroidism will make you want to sleep more. Women with hypothyroidism usually wake up still feeling tired and groggy, no matter how much sleep they got.
Feeling hot & cold: Women who are perimenopausal or menopausal may experience hot flashes, in addition to feeling cold sometimes for no specific reason. Hypothyroidism will make you feel cold, and hyperthyroidism can make you feel hot, and like your heart is racing.
Depressed mood: Hormones regulate much of your emotions and mood. Perimenopause is associated with mood swings, and, some studies show menopause increases the risk of depression. Hypothyroidism can result in depression, while hyperthyroidism may lead to anxiety.
How can you know what’s what? It requires a simple blood test with specific markers that give you a clear answer: go back to my previous article on thyroid and blood markers here.
Get your doctor to check these for you - in most countries they are all covered by insurance.
Make sure you’re getting in all thyroid nutrients and try to eliminate any source of thyroid disruption that I mention in my article. If you want help with managing your thyroid condition naturally or are interested in bio-identical hormone therapy, get in touch so that we can discuss your needs.