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If you feel like your body is starting to play a game of hormonal roulette, you’re not alone. Chances are, you’re entering perimenopause, that not-so-subtle precursor to menopause. Managing it can be a task, especially if you have underactive thyroid.

Hypothyroidism and perimenopause share a complicated relationship, as thyroid hormones play a crucial role in regulating reproductive function. Hypothyroidism can disrupt menstrual cycles, exacerbate hormonal imbalances, and amplify some perimenopausal symptoms.

In this article, we’re exploring the intersection of perimenopause and hypothyroidism. Covering the basics, we’ll discuss how you can prepare yourself for a smoother perimenopause and menopause and reduce your symptoms. 

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Perimenopause is a natural phase in a woman’s life, typically starting in her 40s and ending in her early 50s. It marks the transition towards menopause, the point at which periods have stopped for an entire year. During perimenopause, many women experience hormonal fluctuations as their bodies prepare to cease menstruation entirely. Hormone levels, particularly estrogen and progesterone, begin to decline. 

Perimenopause comes with a range of symptoms—both physical and emotional—which can vary in intensity from woman to woman. Surprisingly, more than 90% of women are never taught about menopause, making them unable to identify the symptoms. Here are some common symptoms to watch out for:

• Irregular periods
• Hot flashes
• Episodes of excessive sweating during sleep (“night sweats”)
• Vaginal dryness
• Changes in libido: decreased interest in sex or changes in sexual desire
• Mood swings, including increasing anxiety and depression
• Sleep disturbances
• Weight gain
• Memory problems. (A surprising 68.3% of women suffer from brain fog during perimenopause and menopause!)

The change in hormonal balance as a woman’s body prepares for menopause is the primary reason for perimenopause. The transition into perimenopause typically begins several years before menopause itself and is influenced by various factors, including:

• Declining ovarian function
• Fluctuating hormone levels
• Aging
• Genetics
• Certain lifestyle factors, such as smoking, excessive alcohol consumption, and poor diet
• Some medical conditions, such as lupus or rheumatoid arthritis
• Surgical removal of the ovaries (oophorectomy) or uterus (hysterectomy)
• Chronic stress
• Chemotherapy and radiation therapy, which can damage ovarian function

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Low thyroid hormone levels (hypothyroidism) can significantly impact the experience of perimenopause. The impact results from the relationship between thyroid hormones and the female reproductive system.

Thyroid hormones – particularly thyroxine (T4) and triiodothyronine (T3) – are crucial in regulating our body’s metabolism and energy production. They also influence the function of the hypothalamic-pituitary-ovarian (HPO) axis, which governs the menstrual cycle and reproductive function. Given this influence, thyroid hormone imbalances can lead to menstrual irregularities, such as oligomenorrhea (infrequent or irregular menstrual periods) or amenorrhea (absence of menstruation).

Additionally, thyroid hormones play a role in the metabolism and clearance of estrogen. Impaired thyroid function can disrupt estrogen metabolism, leading to alterations in estrogen levels and the estrogen-to-progesterone ratio. This imbalance can contribute to or worsen some perimenopausal symptoms, especially hot flashes, mood swings, and vaginal dryness.

And that’s not all. Hypothyroidism can also affect the production and utilization of progesterone, another essential hormone involved in the menstrual cycle and pregnancy. Reduced progesterone levels or impaired progesterone receptor sensitivity can aggravate perimenopausal symptoms, including irregular periods, mood disturbances, or sleep disturbances.

Studies found some other contributing factors, too. These factors include elevated levels of thyroid-stimulating hormone (TSH) and the metabolic changes associated with hypothyroidism, including alterations in lipid metabolism, insulin resistance, and weight gain.

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While thyroid hormone replacement therapy can usually alleviate symptoms of hypothyroidism, its direct impact on perimenopausal symptoms may be limited.

That said, there are some indirect ways in which thyroid hormone replacement therapy can help with certain perimenopausal symptoms, particularly those that are amplified by thyroid dysfunction. Here’s how thyroid treatment may potentially impact perimenopause:

• By stabilizing hormonal balance, thyroid treatment can improve symptoms like mood swings, fatigue, and irritability
• By managing metabolic function, thyroid treatment can help with symptoms like weight gain and sluggishness
• By improving menstrual regularity, thyroid treatment can resolve symptoms such as oligomenorrhea or amenorrhea

Thyroid treatment can also enhance your overall well-being by improving energy levels, cognitive function, and mood stability.

Your Guide To The Genetics Of Thyroid Function

Knowing your risk for thyroid disease can help you stay in front of complications. Learn in this guide how genes impact your risk for hypothyroidism.

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Your first line of defense is over-the-counter (OTC) medications and supplements to help relieve perimenopausal symptoms:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as ibuprofen (Advil, Motrin) or naproxen (Aleve), can help relieve pain associated with menstrual cramps.
• Calcium and vitamin D supplements: They can help support bone health and reduce the risk of osteoporosis, a condition that can become more prevalent during perimenopause and menopause.
• Magnesium supplements: These supplements are known to relieve symptoms like muscle cramps, headaches, and mood disturbances.
• Herbal supplements: Some women find relief from perimenopausal symptoms by taking herbal supplements. For instance, maca, black cohosh, evening primrose oil, or red clover may be effective for some women. 
• Vaginal lubricants and moisturizers: If you’re experiencing vaginal dryness or discomfort during perimenopause, try OTC vaginal lubricants and moisturizers. They are the best option to get relief and improve comfort during intercourse.
• Sleep aids: OTC sleep aids such as diphenhydramine (Benadryl) or doxylamine (Unisom) can be used for sleep disturbances and insomnia.

If symptoms are more debilitating, prescription medications are also available to help relieve perimenopausal symptoms. 

• Hormone therapy, including estrogen-only products like Premarin and estradiol (found in Estrace, Climara) or combination therapies like Prempro (estrogen and progestin) and Activella (estradiol and norethindrone acetate), help manage hot flashes, vaginal dryness, and mood swings.
• Selective serotonin reuptake inhibitors (SSRIs) such as Paxil, Prozac, and Zoloft alleviate mood swings and depression.
• Gabapentin, marketed as Neurontin, and its derivative, Lyrica, are prescribed for hot flashes and mood stabilization.
• Low-dose antidepressants like Effexor and Cymbalta can also mitigate hot flashes, insomnia, and mood disturbances.
• Non-hormonal medications like Brisdelle (paroxetine) and Duavee (conjugated estrogens/bazedoxifene) offer alternative options for symptom management, ensuring a tailored approach to perimenopausal care.
• Prescription drugs for bone health, such as alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), zoledronic acid (Reclast), and denosumab (Prolia), are commonly used to strengthen bones and treat osteopenia and osteoporosis by inhibiting bone resorption and promoting bone formation, thereby reducing the risk of fractures.
• Prescription sleep aids such as zolpidem (Ambien), eszopiclone (Lunesta), temazepam (Restoril), and trazodone (Desyrel) can effectively alleviate perimenopausal sleep problems by promoting sleep onset and maintenance, improving sleep quality and duration.

THYROID GUIDE

Your Guide To Thyroid Medication

Optimizing your thyroid levels with thyroid hormone replacement medication is usually the first step in minimizing symptoms.

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Making lifestyle and diet changes can help decrease perimenopausal symptoms. Here are a few changes to consider incorporating into your routine. 

Eat a healthy diet

Start by maintaining a balanced diet. Opt for a diet rich in whole foods, including fruits, vegetables, whole grains, lean proteins, and healthy fats. Try to include calcium-rich foods (dairy products, leafy greens, and fortified foods) to support bone health. Also, limit your intake of processed foods, sugary snacks, and caffeine, as they can intensify symptoms like mood swings and hot flashes.

You may also want to consider the AIP (Autoimmune Protocol) diet. Rich in nutrient-dense foods and free from potential inflammatory triggers, the AIP may help alleviate symptoms of perimenopause by supporting hormonal balance and reducing inflammation, potentially easing hot flashes, mood swings, and other discomforts associated with this transitional phase.

And don’t forget to stay hydrated. Drinking plenty of water throughout the day can help alleviate symptoms such as fatigue, headaches, and dry skin. 

Exercise regularly

Regular physical activity, such as walking, cycling, swimming, or yoga, is helpful. It can improve your mood and help you maintain a healthy weight. Aim for at least 150 minutes of moderate-intensity exercise per week—or as recommended by your healthcare provider.

Manage stress and prioritize sleep

Many stress-reduction techniques can help with several perimenopausal symptoms. For instance, deep breathing, meditation, mindfulness, or progressive muscle relaxation can help ease anxiety, irritability, and mood swings. Some good sleep can also do the trick! Aim for 7 to 9 hours per night of quality sleep.

Quit smoking and limit alcohol

Smoking can heighten symptoms like hot flashes and increase the risk of osteoporosis. Not to mention that it can have other detrimental effects on your health. Similarly, alcohol can disrupt sleep patterns and contribute to weight gain. Avoid both if you can to help reduce perimenopausal symptoms. 

Get regular check-ups

Another thing that can help is regular health check-ups. Start with the basics: thyroid testing, blood sugar and cholesterol checks, bone density tests, and mammograms. They can help with early detection of problems and may even allow you to avoid them altogether.

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Perimenopause is a transformative phase in a woman’s life. It’s accompanied by a myriad of physical and emotional changes. While managing perimenopausal symptoms can be challenging, understanding the potential impact of hypothyroidism on this transition is crucial for comprehensive care.

If you’re experiencing symptoms of perimenopause, it’s time to take proactive steps towards better thyroid and overall health. Not sure where to get started from? Get your thyroid tested.

A thyroid test can help you determine if hypothyroidism is the underlying cause of your perimenopause. You can try Paloma’s convenient, at-home testing kit. It allows you to test for the four most common thyroid biomarkers (TSH, T4, T3, and TPO) with add-ons like vitamin D and reverse T3. All you need to do is get your test results; our providers will help you with the next steps. 

And don’t forget that Paloma members have access to a nationwide care team of top-quality healthcare practitioners with expertise in hormonal health challenges, including hypothyroidism, perimenopause, and menopause. Find out more about Paloma membership now, and get started on your way to optimal health!

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