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Perimenopause and menopause are characterized by hormonal changes that can affect your physical, mental, and emotional health. At the same time, from perimenopause on, women are at higher risk of hypothyroidism–an underactive thyroid. If you are hypothyroid, and going through perimenopause or you’re menopausal, adopting specific lifestyle changes can help greatly ease the hormonal transitions and improve your overall well-being during this time. From dietary modifications to stress management techniques, here are some of the best lifestyle changes to help you more easily manage these hormonal transitions when you’re hypothyroid. 

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First, let’s define perimenopause and menopause, which are significant transitional phases in your reproductive life. Perimenopause typically begins several years before menopause—usually in your 40s – and is usually a gradual process characterized by fluctuating hormone levels and irregular menstrual cycles. During this stage, you may experience symptoms such as hot flashes, mood swings, and changes in sex drive, among others.

Menopause, on the other hand, marks the point when it’s been 12 consecutive months since you’ve had a menstrual period. Menopause represents the permanent end of menstruation and the end of the reproductive phase of a woman’s life. The average age of menopause in the U.S. is 51. Symptoms like hot flashes, night sweats, vaginal dryness, and mood changes may, however, persist into menopause and the post-menopausal period.

Drug-based treatments for the symptoms of perimenopause and menopause typically involve hormone replacement therapy (HRT), which aims to relieve symptoms by supplementing declining estrogen levels. HRT may include estrogen alone or be combined with progestin for women who still have a uterus. HRT can be effective in managing symptoms such as hot flashes, night sweats, vaginal dryness, mood changes, and sleep problems. At the same time, specific lifestyle changes can also help relieve menopausal symptoms, whether used as stand-alone approaches or to complement traditional HRT. Let’s look at some of the best lifestyle changes to consider.

The risk of hypothyroidism is higher in women over 40 – the decade when perimenopause usually starts. Several factors contribute to this risk, including age-related changes in thyroid function, increased susceptibility to autoimmune disorders, and the hormonal fluctuations of perimenopause and menopause. As women age, the likelihood of developing conditions that can lead to hypothyroidism, such as Hashimoto's thyroiditis, also increases. 

Additionally, the hormonal changes associated with perimenopause and menopause, including fluctuations in estrogen and progesterone levels, can affect thyroid function and contribute to the development of hypothyroidism. Overall, the combination of age-related changes, hormonal fluctuations, and increased susceptibility to autoimmune disorders and other health conditions contributes to the higher risk of hypothyroidism in women over 40.

The good news is that there are many lifestyle changes that will help perimenopausal and menopausal symptoms, as well as support thyroid health. Let’s take a look at these chanages. 

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A balanced diet plays a crucial role in mitigating the symptoms associated with perimenopause and menopause. Incorporating a variety of whole foods rich in vitamins, minerals, and phytonutrients can promote hormonal balance and help alleviate common issues like hot flashes and mood swings.

Eat enough protein

Protein supports muscle mass, which tends to decrease starting in perimenopause. Good sources include lean red meats, fish, poultry, legumes, nuts, and seeds.

Get enough omega-3 fatty acids

Essential fatty acids, especially omega-3s,  found in foods like salmon, avocado, nuts, flaxseeds, walnuts, and seeds can help maintain hormonal balance and reduce chronic inflammation, easing symptoms like joint pain and mood swings.

Eat a fiber-rich diet

Fiber-rich foods – like fruits, vegetables, legumes, and whole grains – promote digestive health, can help manage weight, improve constipation, and may reduce the risk of heart disease seen in hypothyroid women, and women during perimenopause and post-menopause.

Focus on calcium-rich foods

Bone health becomes particularly important during menopause due to declining estrogen levels. Incorporate calcium-rich foods like leafy greens, dairy products, tofu, and almonds into your diet to support bone density. You also want to include Vitamin D-rich foods in your diet. Both nutrients are vital for bone health and can help counteract the increased risk of osteoporosis during and after menopause.

Eat healthy fats

Foods like flax seeds, chia seeds, and avocados help with nutrient absorption and may reduce menopause symptoms, and hypothyroidism symptoms such as dry skin, and dry brittle hair.

Limit saturated fats and refined foods

Reducing your intake of saturated fats and highly refined foods can help manage weight, reduce the risk of heart disease, and lower inflammation, which increases during and after menopause due to lower estrogen levels. Inflammation also increases in hypothyroidism, and particularly, autoimmune Hashimoto’s thyroiditis. 

Increase your intake of phytoestrogens

Foods such as soybeans, flaxseeds, chickpeas, and lentils contain phytoestrogens, which can mimic the effects of estrogen in the body and help alleviate menopausal symptoms.

An important note: be careful about overdoing the phytoestrogenic foods. Too much can affect your ability to absorb and process thyroid hormone effectively. 

Stay hydrated

Staying well-hydrated is crucial for overall health and hormonal balance, and can help manage weight.

Incorporate anti-inflammatory foods and spices

Turmeric, ginger, seeds, tinned fish, sea vegetables, legumes, and fermented foods have anti-inflammatory benefits. This is important because estrogen and testosterone – which have anti-inflammatory effects – decline during perimenopause and menopause. In addition, it’s especially important for women with autoimmune Hashimoto’s thyroiditis, which is characterized by higher levels of inflammation. 

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Regular exercise is essential for maintaining overall health and well-being during perimenopause and menopause. Research shows that exercise is associated with significant reductions in the severity and frequency of menopausal symptoms. For menopausal and hypothyroid women, physical activity not only helps manage weight and prevent bone loss but also alleviates mood swings and improves sleep quality.

The goal should be at least 150 minutes of moderate aerobic activity per week. This can be broken down into shorter sessions throughout the week to make it more manageable.

A combination of endurance (aerobic), strength, and balance and flexibility exercises is recommended for women in perimenopause and menopause:

• Endurance/aerobic activity: Aerobic activities like brisk walking, cycling, and dancing improve cardiovascular health and help burn calories for weight management.
• Strength training:  Strength training with weights or resistance bands helps preserve muscle mass and bone density, reducing the risk of osteoporosis and promoting a healthy metabolism.
• Balance and flexibility exercises: Activities like yoga and t’ai chi can improve flexibility, balance, and posture, reducing the risk of falls and enhancing overall physical function as you age.

A special note about yoga: One major review and meta-analysis study looked at the impact of yoga on menopausal symptoms and found that regular yoga practice is associated with significant reductions in the frequency and severity of menopausal symptoms, including hot flashes and night sweats.

Don’t forget to always begin physical activity, sports, exercise, and fitness classes with a warm-up to prepare the body for exercise and reduce the risk of injury. This is especially important as the body becomes less flexible with age.

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Stress management is crucial during perimenopause and menopause – and for people with hypothyroidism – because stress can negatively affect hormonal balance and overall well-being. The hormonal fluctuations that occur during perimenopause and menopause – combined with an underactive thyroid –  contribute to increased stress levels, exacerbating symptoms such as fatigue, hot flashes, anxiety, irritability, and sleep disturbances. Chronic stress can further disrupt hormone levels, leading to more severe menopausal and hypothyroidism symptoms and worsening overall health outcomes. In addition, stress can negatively affect cardiovascular health, bone density, and immune function, which are already vulnerable during the menopausal transition and in women with hypothyroidism.

Incorporating relaxation techniques into your daily routine can help alleviate stress, inoculate you against the adverse effects of stress, and promote emotional well-being. Here are some ways to introduce stress management into your daily routine.

• Practice mindfulness and relaxation techniques: Deep breathing, yoga, guided meditation, and stretching exercises can help manage stress and menopause-related symptoms. These practices promote relaxation and can improve sleep quality.
• Engage in relaxation exercises: Techniques such as breathwork, progressive muscle relaxation, yoga nidra (yoga sleep), and guided imagery can promote relaxation and reduce the physical symptoms of stress, reduce the intensity and frequency of hot flashes, and alleviate symptoms such as muscle tension and rapid heartbeat.
• Find enjoyable activities:  Engaging in activities that bring joy can be a natural stress reliever. Whether it’s a hobby, socializing with friends, or spending time in nature, find what works for you and make it a part of your routine.
• Prioritize self-care: Make time for activities that bring you joy and relaxation, whether reading a book, taking a bath, or spending time in nature. Prioritizing self-care can help replenish your energy and resilience during this transitional period.

There’s research to support the benefits of these practices. Studies show that interventions such as mindfulness-based therapy can improve anxiety and depression in menopause and hypothyroidism, as well as cognitive function and brain fog.

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Sufficient quality sleep is critically important during perimenopause and menopause for several reasons:

• Hormonal regulation: Sleep is vital in regulating hormone levels, including estrogen and progesterone, which decline during menopause, and thyroid hormone. Disruptions in sleep patterns can further exacerbate hormonal imbalances, leading to increased menopausal symptoms such as hot flashes, mood swings, irritability, and weight gain, and hypothyroidism symptoms.
• Mood and emotional well-being: Sleep disturbances can have a significant impact on mood and emotional well-being, contributing to feelings of irritability, anxiety, and depression commonly experienced during perimenopause and menopause. Quality sleep is essential for emotional regulation, stress management, and overall mental health.
• Cognitive function: Adequate sleep is crucial for cognitive function, including memory, concentration, and decision-making abilities. Sleep disruptions due to perimenopause, menopause, and hypothyroidism may impair cognitive function, leading to difficulties in daily tasks and reduced quality of life.
• Physical health: Chronic sleep deprivation is associated with an increased risk of various health conditions, including cardiovascular disease, diabetes, obesity, and immune dysfunction. Women who are hypothyroid and experiencing perimenopause and menopause are already at heightened risk for specific health issues, and sleep disturbances can further exacerbate these risks.
• Bone health: Sleep deprivation can negatively impact bone health and contribute to decreased bone density, increasing the risk of osteoporosis and fractures, which are already heightened concerns during menopause due to declining estrogen levels.

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Ways to improve sleep

Quality sleep is essential for overall health and well-being, yet many women

experience disruptions in sleep patterns during perimenopause and menopause due

to hormonal changes and night sweats. Here are some number of practical ways to help encourage sufficient, better quality sleep.

First, create a relaxing sleep environment by keeping your bedroom cool, dark, and quiet. Consider using blackout curtains, earplugs, or white noise machines to minimize disturbances if necessary.

You should also maintain a regular sleep schedule. Going to bed and waking up at the same time every day can help regulate your body’s internal clock and improve sleep quality.

You can also use foods and supplements, such as melatonin, melatonin-rich tart cherry juice, and tryptophan-rich foods, to help improve sleep. Nutritional interventions may alleviate menopause-related sleep disturbances, as studies have shown they can improve relevant aspects of sleep.

Practice good sleep hygiene by avoiding caffeine, nicotine, and alcohol close to bedtime, as they can disrupt your sleep patterns. Additionally, limit screen time before bed and engage in relaxing activities to signal to your body that it’s time to wind down.

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When you’re in perimenopause or menopause,  there are many good reasons to quit smoking.

• Increased risk of early menopause: Smoking has been linked to an increased risk of early menopause. According to research, women who smoke more than 20 cigarettes per day are at a higher risk of experiencing menopause at an earlier age compared to non-smokers.
• Worsening of symptoms: Smokers are more likely to have more symptoms during perimenopause and menopause, including more severe hot flashes.
• Health risks: Smoking and menopause have overlapping negative health consequences, which may act synergistically to contribute to various health challenges. Quitting smoking can help reduce those risks.

Note: Smoking also increases the risk of developing an autoimmune disease and may contribute to the development of overt hypothyroidism in patients with Hashimoto’s thyroiditis.

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To help reduce perimenopausal and menopausal symptoms, consider reducing your intake of alcohol. Alcohol has several adverse effects, including:

• Worsening of menopausal symptoms: Alcohol can exacerbate menopausal symptoms such as hot flashes, night sweats, and sleep problems. The majority of women experience these symptoms, and alcohol can make them worse.
• Increased health risks: During menopause, the risk of certain health conditions, including heart disease and osteoporosis, increases. Alcohol consumption can further elevate these risks.
• Disrupted sleep: Alcohol can disrupt the quality of your sleep.
• Weight gain: Drinking too much alcohol can contribute to weight gain during menopause, making it harder to maintain a healthy weight.

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Protecting your bone health during perimenopause and menopause is crucial due to the significant risk of bone loss and the development of osteoporosis associated with these stages of life. Women can lose up to 10% of their bone mass in the first five years after menopause. In addition, the decline in estrogen levels during perimenopause and menopause leads to an increase in bone resorption (breakdown) and a reduction in bone mineral density, making your bones weaker and more susceptible to fractures and increasing your risk of osteoporosis and fractures.

To protect bone health, especially during perimenopause and menopause, it’s essential to ensure adequate calcium and vitamin D intake through diet, supplements, and sunlight exposure, as they are crucial for bone structure and calcium absorption. Regular physical activity – including weight-bearing and resistance exercises like walking, running, and strength training – plays a significant role in maintaining or improving bone density. Adopting a healthy lifestyle by avoiding smoking and limiting alcohol consumption is also vital, as these habits can exacerbate bone loss. For some women, hormone therapy may be recommended to mitigate bone loss due to decreased estrogen levels. Additionally, regular bone density testing can help detect early signs of osteopenia or osteoporosis, allowing for timely intervention.

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Perimenopause and menopause are natural stages of life that can be successfully managed by embracing thoughtful lifestyle changes. All women – including women with hypothyroidism – can navigate these transitions more comfortably by focusing on a nutritious diet, regular exercise, stress management, quality sleep, and avoiding harmful habits like smoking and excessive drinking.

It’s also important to recognize that while traditional “menopause” symptoms like fatigue, weight gain, brain fog, mood changes, and low sex drive are also symptoms of an underactive thyroid. When you join Paloma Health, you’ll have access to Paloma’s hormone-savvy team of healthcare practitioners who can help ensure that your reproductive hormones and your thyroid are well-balanced and fully supporting your long-term health and vitality.

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