Thyroid health
Hypothyroidism in menopause — a whole-body perspective
by Marcelle Pick, OB/GYN NP & Dixie Mills, MD
We so often see the connection between thyroid dysfunction and menopause overlooked
— not only by women who tell us they “feel old before their time,” but also by many
healthcare providers.
After all, if you suffer from hypothyroidism, an underactive thyroid, we understand
how easy it can be to attribute frustrating symptoms of weight gain, fatigue, poor
concentration, and hair loss to menopause — and not realize that maybe something
else is going on.
And we see how hypothyroidism and menopause may “sneak up on you” even if you’ve
been taking good care of yourself. That’s because the reproductive hormone changes
that naturally take place in your body in menopause are accompanied by changes to
thyroid function, too. And, if an imbalance or predisposition has been present but
left unaddressed, it can lead to hypothyroidism. Sometimes the condition is transient
or subclinical, but sometimes not — many women develop a clinical thyroid problem
in menopause and are put on lifelong medication.
Key Points
Symptoms of hypothyroidism, perimenopause, and menopause are related and overlapping.
Hormonal changes in menopause can unmask an underlying thyroid problem or trigger
one — 20% of menopausal US women have been diagnosed with thyroid dysfunction.
Many women remain undiagnosed because their symptoms are attributed to menopause,
or their thyroid test results look “normal.”
Simple diet, supplements, and lifestyle measures can support healthy thyroid function.
Finally, you may not make the connection because your healthcare provider isn’t
making it, either! You might be surprised to know that many practitioners categorize
thyroid health as “normal” or “abnormal” based on a single test result. We know
women’s bodies are more complex than that — so we look at overall patterns and trends
to help you feel better now, rather than just waiting for your symptoms to get worse!
To help you understand your options, let’s take a look at thyroid function and how
hormonal fluctuation fits into the equation.
What is hypothyroidism?
Your thyroid plays a key role in helping you metabolize food, store and use energy,
manage your weight and heat control, think, talk, sleep, and reproduce.
Hypothyroidism means “low thyroid function,” meaning underproduction of
the hormones needed to support your activity on a daily basis. As a result, you
may feel like a computer with a very bad internet connection – working, but certainly
not at top speed.
Normally, your brain and thyroid communicate with your body to maintain optimal
balance of these hormones. In this healthy state, the brain produces thyrotropin-releasing
hormone (TRH) and thyroid-stimulating hormone (TSH). These hormones
then prompt your thyroid gland to produce the active thyroid hormones called T4
(thyroxine) and T3 and (triiodothyronine) whenever levels are
low. Ultimately, the body works to convert T4 into T3, the form our cells recognize
best and use most effectively.
Overlapping symptoms of hypothyroidism and menopause
We see many women develop subclinical or overt hypothyroidism in menopause. Here
is one scenario depicting hormonal changes that can prompt symptoms.
Note: Endocrine imbalances can arise for many different reasons. It’s always a good
idea to keep track of your symptoms and keep your healthcare practitioner informed,
especially if you’re already taking thyroid medication.
As you can see, this is a dynamic system, designed to adjust itself from moment
to moment to meet your body’s continually changing needs. So as long as things haven’t
gotten too far out of synch, this system will always move toward balance — provided
you support it!
Is it menopause, hypothyroidism — or what?
When we talk with a woman who complains of fatigue, weight gain, low sex drive,
hair loss and depression, we often find she is in
perimenopause or menopause. But she may also have some degree of thyroid
imbalance or even hypothyroidism. Symptoms overlap because our thyroid and reproductive
hormones axes are so closely interconnected.
In menopause, our bodies produce fewer reproductive hormones because we need fewer
of them during the second half of our lives. Estrogen enhances the ability of TRH
to do its job. And that means that as you begin to produce less estrogen, your thyroid
function can slow down a bit, too — especially if the drop is a sudden or dramatic
one (see illustration).
Menopause can “tip the scale” to hypothyroidism
You may have lived your entire life without realizing you were vulnerable to thyroid
imbalance. Ideally, the body’s checks and balances serve to smooth out the major
transitions women experience across their lifespan. But lots of factors common to
life on earth — especially stress, environmental exposures, suboptimal nutrition,
or simply our genetic blueprint — predispose us toward a bumpier ride. Add reproductive
flux to the mix — menstruation, birth control, childbearing, perimenopause, menopause,
HRT — and it’s no mystery as to why we’re more prone to thyroid disorders than men!
The adrenal glands are another endocrine organ with close connections to thyroid
function. When your adrenals don’t work well, your thyroid also doesn’t work well.
Learn more in our article on adrenal and thyroid
function.
When the complex feedback loops of the endocrine system veer off-center, hormonal
imbalances like thyroid dysfunction commonly result. And with suboptimal levels
of thyroid hormones, your cells cannot produce healthy biological responses, and
you begin to experience symptoms. This can be especially frustrating for women who
have been extremely health conscious.
Sometimes the origins of thyroid imbalance don’t lie within the thyroid gland itself,
but rather in other parts of the endocrine system. As part of your body’s endocrine
system, the thyroid is constantly engaged with other endocrine glands in a series
of complex feedback loops.
Why a “normal” thyroid can still cause symptoms in menopause
If you are experiencing symptoms, your healthcare practitioner may run a test to
measure your TSH levels. The test will show higher levels of TSH if your T4 and
T3 are low. This indicates that your pituitary gland is working hard to produce
enough TSH to stimulate production of T4 and T3, as well as convert T4 to T3.
While the “normal range” for labs that test TSH may be as high as 4.0mlU/L, we generally
like to see TSH blood level tests come closer to 2.0 mlU/L.
Why the difference? In our experience, there is a very real difference between what
some practitioners accept as normal and what’s truly ideal for you as an individual.
In fact, at the Women to Women Clinic we use a broader thyroid panel as a screener
for symptomatic women in menopause. While about 20% of women are within the “normal”
range, we see another 35% with subclinical hypothyroidism according to their test
results!
We also look at changes that take place over time, patterns, and trends — as well
as all the other factors known to influence your hormonal health. This is especially
important during menopause, when even small changes can be part of a very real hormonal
imbalance. That way, you can begin a program to provide support naturally — before
more severe symptoms develop.
Here are other ranges that conventional medical practitioners see as normal. Remember,
if you have symptoms or test results showing a trend upward, we feel it is important
to have your thyroid function thoroughly evaluated by an experienced practitioner,
regardless of initial test results.
- T4: 4.8–13.2 mcg/dL
- Free T4: 0.9–2 ng/dL
- T3: 80–200 ng/dL
- TSH: 0.4–4.0 mIU/L (if you have no hypothyroid or hyperthyroid
symptoms) 0.3–3.0 mIU/L (if you’re being treated)
Reference
Making thyroid health a priority is especially important during menopause, because
with all the changes going on in your body and mind, even small adjustments can
make a significant difference in relieving frustrating symptoms.
When your thyroid needs more support
One of the best ways to enjoy healthy thyroid function is to rebuild a foundation
of support for the endocrine system as a whole. This includes optimizing ratios
between all your hormones during perimenopause and menopause — estrogen, progesterone,
and testosterone — rather than targeting the level of any single hormone.
Maintain your healthy thyroid
The best way to nourish your thyroid function (and your general health) is through
sound nutrition, including daily supplementation with a medical-grade multivitamin–mineral
complex — including selenium, iodine vitamin A, and zinc.
Regular screening and well-woman exams are also great preventatives. If you have
a family history of thyroid conditions, be sure to inform your healthcare provider
and ask for thorough testing if you notice symptoms.
Our experience at the Women to Women Clinic has shown us that starting with a gentle,
natural approach often restores normal thyroid function and decreases the overlapping
symptoms, and we add thyroid medications only if necessary, favoring naturally-sourced
thyroid medications.
Here are some simple measures you can take to support your thyroid naturally:
Nourish yourself. Your body needs a wide range of nutrients
replenished daily to manufacture and metabolize all its hormones, including thyroid
hormones. Vitamin A, EPA and DHA, and zinc, for example, act to improve T3 binding
in your cells. Iodine is the central ingredient in thyroid hormones T3 and T4. Trying
to produce T3 and T4 without iodine is like trying to make an omelet without eggs!
Selenium is also need for the conversion of T4 to T3, so if you are deficient, increasing
dietary intake can make a big difference.
Fresh whole foods are always the ideal source for nutrients. But in reality, nearly
every patient we see with thyroid problems has a less than ideal diet. A pharmaceutical-grade
multivitamin–mineral complex, such as the one in our Personal Program for Hormonal
Imbalance, can function much like a bridge over nutritional gaps.
The role of thyroid medications
If you have a thyroid imbalance, you may want to talk to your practitioner about
the possibility of using natural measures before initiating prescription medication.
One drawback to thyroid replacement drugs like Synthroid (levothyroxine) is that
once you go on them, the thyroid backs down its own production, so it can be difficult
or impossible to ever discontinue the drug.
On the other hand, if you have adopted natural measures and your thyroid levels
still aren’t right — or you are still experiencing symptoms — a prescription for
natural thyroid hormones
may be worth consideration.
Healing herbs from Mother Earth. Certain phytotherapeutic
herbs help women in menopause recalibrate the ratios between estrogen, progesterone,
and testosterone. Balance among these hormones supports healthy functioning throughout
your entire endocrine system, including the thyroid.
Diminish the effects of stress in your daily life. Chronic
stress has powerful, detrimental effects on your endocrine system. Hormones released
as part of the stress response interfere with the production, metabolism and/or
utilization of both sex hormones and thyroid hormones. You may not be able to eliminate
stress in your life, but you can take measures to minimize its impact, such as regular
meditation and moderate exercise.
Remember, hypothyroidism is rarely an isolated condition — especially in menopause.
When you look at all the connections, you will start to understand that when the
issues underlying hormonal imbalance are resolved, it’s amazing how much better
you can feel. So whatever your lab test results may be, you can make choices to
feel better naturally.
Relieve your troubling thyroid symptoms by restoring hormonal balance.
From our experience, we know that thyroid health is linked to hormonal balance.
That’s why we recommend our Personal Program for women with thyroid symptoms. You
get it all — targeted formulas for symptom relief, real-life diet and lifestyle
assistance, and supplementation for a strong nutritional foundation. Plus we give
you the one-on-one support that so many women believe is the key to their success.
- Take a look at how the Personal
Program for Hormonal Imbalance works to relieve symptoms.
- Call us at 1-800-798-7902 to ask us a question about your symptoms
and let us help you choose the Program that’s perfect for you. We’re right here
in Portland, Maine ready to listen and help.
- Find out more about how your symptoms may be thyroid-related and take our Hormonal Health Profile.
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Related to this article:
References & further reading on hypothyroidism
in menopause
Last Modified Date: 05/26/2011
Principal Author: Marcelle Pick, OB/GYN NP