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As you go through menopause, your body undergoes significant changes. These hormonal shifts can affect how you feel, both physically and emotionally. Menopause can significantly impact your emotional and sexual well-being. This issue can be compounded in women who also have hypothyroidism – an underactive thyroid. In this article, we’ll look at how hormonal shifts affect your sexual desire and sexual function and the steps needed to rediscover sexual fulfillment.

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Estrogen and progesterone, the two main female sex hormones, regulate your menstrual cycle and prepare your body for pregnancy. Your levels of these hormones naturally fluctuate throughout your life.

Hormones are significant in keeping your body running smoothly throughout your life. The time before menopause, known as perimenopause, can start in your 40s and sometimes even earlier. During perimenopause, your hormone levels begin to fluctuate, leading to symptoms like irregular periods, hot flashes, mood changes, and night sweats. These result from the decline in estrogen and progesterone levels as you approach menopause. The hormonal decline is what triggers the end of your menstrual periods, and the point at which menstrual periods have stopped for a year is defined as menopause. Menopause typically happens around age 51 in the U.S., but every woman’s experience is different.

During perimenopause and after menopause – and more so if you’re also dealing with thyroid issues – hormones can get out of balance, creating a domino effect on your health and well-being. While symptoms like hot flashes and erratic periods are talked about the most, the impact that perimenopause and menopause have on your sex life often remains in the shadows.

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Thyroid hormones help control how fast your body uses energy, how you feel, and even your mood. The main hormones made by the thyroid gland are triiodothyronine (T3) and thyroxine (T4).

If your thyroid isn’t working right, it might not make enough hormones (hypothyroidism), or it might make too much (hyperthyroidism). Both problems can make you feel tired, depressed, and anxious and disrupt sleep, which are also symptoms of menopause.

Thyroid conditions are more common in women, and the risk of developing a thyroid condition increases in women in perimenopause and menopause. This can cause some confusion because the hormonal changes of perimenopause and menopause cause some similar symptoms to thyroid problems have other similar symptoms. For example, having insufficient thyroid hormone – hypothyroidism – can cause weight gain and a lower sex drive, which are also common during menopause.

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The decrease in estrogen during perimenopause and menopause can affect your thyroid function as well, in several ways:

• Decreased T4 to T3 conversion: Estrogen helps convert the inactive thyroid hormone T4 to the active form T3. Your body needs T3 to function properly. When estrogen levels drop, this conversion can become less efficient and can result in hypothyroidism symptoms.
• Increased TSH levels: The pituitary gland, located in your brain, controls your thyroid. When it detects lower levels of T3, it can ramp up the production of thyroid-stimulating hormone (TSH) to try and get your thyroid working harder. This can sometimes lead to abnormal TSH levels in blood tests.

Understanding this hormonal connection is crucial. It explains why some women have more severe menopausal symptoms or why some thyroid issues seem to worsen during menopause.

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Menopause brings on many physical changes. Here are some of the physical changes that can have an impact on your sex life.

• Vaginal dryness: Your vaginal tissues can become dry and hold less moisture due to reduced hormone levels. This vaginal dryness, vaginal atrophy, and lack of vaginal lubrication can make sexual activity uncomfortable, or you may even experience pain during sex. 
• Pelvic floor weakness: The muscles holding up your bladder and uterus can weaken during menopause. This can lead to leakage of urine and may make you feel less interested in sexual intimacy.
• Reduced sex drive: A drop in reproductive hormones during menopause can make you feel less interested in sex. You may also experience a loss in libido because you feel tired from other menopausal symptoms or as a result of stress or low mood.
• Mood swings: Feeling emotional during menopause is common. In some cases, it can lead to feelings of anxiety or depression. These emotional shifts can also reduce your interest in being intimate.

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Menopause and thyroid disorders can both bring on a wave of changes that might feel confusing.

Menopause and thyroid problems have other common symptoms, and that can make it tricky to pinpoint the cause. One common symptom is a reduced sex drive or even a lack of libido. Other common symptoms include:

• Fatigue: feeling fatigued, needing more sleep, or unrefreshed after sleep.
• Weight gain: especially unexplained weight gain without changes in diet or exercise
• Sleep disruptions: including trouble falling asleep, difficulty staying asleep, and frequent waking
• Mood changes: including anxiety and depression
• Menstrual changes: including irregular periods or the absence of periods.
• Hair and skin changes: including dry skin and hair loss/thinning hair

In addition to vaginal dryness and pelvic floor weakness, hot flashes and night sweats are unique to perimenopause and menopause and not typically seen with thyroid issues.

The loss of hair from the outer edge of the eyebrows is a unique symptom of hypothyroidism and is not commonly seen in hypothyroidism.

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Menopause brings changes, but it doesn’t mean intimacy with your partner has to end. The good news? You can still have a great sex life during and after menopause! Here are some tips.

Work with your healthcare provider

If sex is a problem, make sure that you don’t have an undiagnosed or insufficiently treated thyroid condition. Hypothyroidism diagnosis and treatment to optimize your thyroid function can help reduce and relieve some of the symptoms attributed to perimenopause and menopause or reduce their severity. You’ll want practitioners – like the knowledgeable members of Paloma’s team – who specialize in women’s hormonal health. They can help you figure out what’s going on and find ways to treat both perimenopausal/menopausal symptoms and your thyroid problems. They’ll work with you to create a personalized plan to get your health – and sex life – back on track!

Consider medications

Discuss with your doctor about medication options to manage menopause symptoms. Your doctor might suggest hormonal treatments such as estrogen creams to ease vaginal dryness or systemic hormone replacement therapy (HRT) for hot flashes and night sweats, tailored to your individual needs. Your healthcare provider can also recommend prescription and over-the-counter medications to help with sleep problems, mood changes, and other symptoms.

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Connect with your partner

There are many ways to keep your sexual relationship exciting.

• Be open with your partner: Let them know what’s going on and what you need. Knowing your partner cares is essential. Words of love and affection can boost your mood and make intimacy more fulfilling.
• Physically connect: Cuddling, kissing, and massage are all great ways to feel close. But don’t be afraid to experiment. Try new things to discover what you both enjoy.
• Relax and communicate: Stress is a common cause of loss of sex drive. Try unwinding together with activities like deep breathing or meditation. Communication is key. Talk openly about what feels good for each other. The more you talk, the better things can be.
• Find your pleasure zones: Everyone has areas that feel extra good when touched. Explore each other’s bodies and see where it takes you.
• Experiment with positions: Variety is the spice of life. Try different positions to find what feels comfortable and enjoyable for both of you.
• Embrace external stimulation and body positivity: Menopause can sometimes make arousal more difficult. Explore using vibrators or other tools to enhance your experience. Remember, feeling good about your body is vital at any age. Embrace your body and all its changes.

Practice self-care

Don’t forget how important it is to take care of yourself. Eat healthy and nutritious foods, get physical activity, prioritize sleep, and practice stress management techniques. Feeling good about yourself from the inside out helps your sex life, too.

Menopause doesn’t have to stop you from enjoying intimacy. By understanding the changes and taking, you can keep your sex life happy and healthy. By working together with your partner, trying new things, and prioritizing self-care, you and your partner can keep the spark alive throughout menopause and beyond.

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Paloma understands that menopause and thyroid problems can be confusing and they can affect a healthy sex life. We want to help. We have resources to help you understand these issues, diagnose and treat them, and guide you through making healthy changes to get your health and sex life back on track.

When you join Paloma Health, you can access convenient at-home thyroid tests, virtual visits with top healthcare providers, personalized advice on what to eat, and a supportive environment to help you optimize your health in both body and mind.

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