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Perimenopause is a phase in your life when your body begins the natural transition to menopause. The journey through perimenopause can bring a rollercoaster of hormonal changes, with unexpected twists and turns. Now, imagine navigating this already tumultuous ride while your body is already grappling with the effects of hypothyroidism! The impact of an underactive thyroid on other hormones, mental health, cognition, and overall well-being can add an entirely new dimension to this phase of life.

When you find yourself at the intersection of perimenopause and hypothyroidism, it’s crucial to understand and manage the complex interplay between these two conditions. From mood fluctuations to cognitive challenges, the combination of perimenopause and hypothyroidism presents a unique set of hurdles that demand a tailored approach to support your health.

In this article, we’ll look at what women with hypothyroidism need to know about perimenopause.

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Perimenopause – sometimes referred to as the menopausal transition –  is characterized by changes in the body’s production of estrogen and progesterone.

Perimenopause usually begins with the first onset of menstrual irregularity, which can begin as early as a woman’s mid-30s, but it most often starts in women aged 40 to 44. During perimenopause, the level of estrogen, the main female hormone, in the body rises and falls unevenly. This leads to various changes in the menstrual cycle and hormone levels. Ovulation becomes less regular, and the ovaries produce less estrogen and other hormones, leading to shorter and more irregular menstrual cycles. As estrogen levels decrease, it can cause symptoms such as hot flashes, night sweats, and other menopausal symptoms.

There are two stages to perimenopause: the early transition, where cycles are mostly regular, with relatively few interruptions, and the late transition, where the time between periods becomes more prolonged and lasts for at least 60 days.

The average length of perimenopause is about four years, but it can last anywhere from a few months to up to 10 years. Perimenopause ends when a woman has gone 12 months without a menstrual period, at which point menopause is complete, and the post-menopausal period begins.

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The intensity and frequency of symptoms can vary significantly among women, but in general, the signs and symptoms of perimenopause include:

Irregular Periods: As ovulation becomes more unpredictable, the length of time between periods may be longer or shorter, your flow may be light to heavy, and you may skip some periods.

Vaginal Dryness: Decreasing estrogen levels can lead to vaginal dryness, which may cause discomfort during sex.

Hot Flashes: Sudden feelings of warmth, typically in the upper body, are common during perimenopause.

Chills: Some women may experience chills as a counterpart to hot flashes.

Night Sweats: These hot flashes occur at night and can disrupt sleep.

Sleep Problems: Many women report insomnia or disturbed sleep during perimenopause, which can be related to night sweats or other factors.

Mood Changes: Mood swings, irritability, depression, and anxiety may occur during this time.

Weight Gain and Slowed Metabolism: Some women may notice an increase in weight and a decrease in their metabolic rate during perimenopause.

Changes in Sexual Desire: Fluctuations in hormone levels can lead to changes in libido.

Brain Fog/Trouble Concentrating: Some women report difficulties with focus and concentration.

Headaches: Hormonal changes can sometimes trigger headaches or migraines.

Joint and Muscle Aches: Some women experience aches and pains in their joints and muscles.

Breast Tenderness: Hormonal fluctuations can also cause breast tenderness.

Urinary Issues: Increased frequency of urination, incontinence, and urinary tract infections can occur.

Some lesser-known perimenopausal symptoms include:

• Worsening body odor
• A “fishy” vaginal odor
• Tinnitus, ringing in the ears
• Heart palpitations
• Burning mouth
• Thinning hair
• Itchy skin
• Inner trembling, tremors, vibrations, and body buzzing
• Tingling in the extremities
• Dry mouth
• Dry eyes
• Dental problems
• Reduced sex drive
• Clumsiness
• Bruising easily
• Brittle fingernails
• Voice changes, hoarseness, lowered pitch
• Taste changes
• Dizziness and vertigo
• Increase in allergies
• Reactions to soaps and perfumes, contact dermatitis

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Perimenopause is a gradual transition, and no single test or sign is enough to determine if a woman has entered this phase. Doctors also consider a woman’s age, menstrual history, and the symptoms or body changes she’s experiencing.

In some cases, your practitioner may order blood tests to check hormone levels, such as a Perimenopause Panel, which measures:

• Follicle-stimulating hormone (FSH), which tends to increase during perimenopause.
• Luteinizing hormone (LH), a hormone that increases at mid-cycle to cause the release of eggs (ovulation). High levels of LH can indicate perimenopause
• Estradiol, which tends to decrease during perimenopause
• Thyroid-stimulating hormone (TSH) levels

You can also get over-the-counter perimenopause test kits to measure hormone levels at home. These tests can provide information that may help you make informed decisions about your health, but they are not designed for diagnosis. They should be used in consultation with a medical professional. Some popular perimenopause test kits include the EverlyWell Perimenopause Test, Clearblue Menopause Stage Indicator, reveal Menopause Test, myLAB Box At Home Perimenopause Test, and LetsGetChecked Female Hormone Test. These tests typically frequently measure FSH, which tends to increase during perimenopause. These kits also often test estradiol and progesterone using blood, saliva, or urine samples. The cost of these test kits can vary, ranging from under $25 to over $100.

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Perimenopausal symptoms can be managed through a variety of medical treatments, depending on the specific symptoms experienced.

• Hormone Therapy: Estrogen therapy is the most effective treatment for hot flashes and night sweats. Women who have had a hysterectomy can take estrogen alone, while those with a uterus need a form of progesterone in addition to estrogen. These medications are typically taken orally or applied as gels, creams, or patches. Hormone therapy can also help level out hormone levels and manage irregular periods.
• Vaginal Estrogen: Estrogen gel or cream applied vaginally or estrogen tablets or rings can help relieve vaginal dryness and discomfort with intercourse.
• Antidepressants: Certain antidepressants, such as paroxetine (Brisdelle), venlafaxine (Effexor XR), citalopram (Celexa), and escitalopram (Lexapro), are used to treat hot flashes, especially for women who can’t use hormones. They are also helpful with depression, anxiety, and sleep problems during perimenopause.
• Anti-Seizure drugs: Anti-seizure drugs like gabapentin (Neurontin) may also help reduce hot flashes.
• Sleep Aids: Over-the-counter sleep aids, such as melatonin, and prescription medications, may be used briefly to help with sleep problems.

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Herbal supplements, vitamins, minerals, botanicals, and lifestyle changes can play a supportive role in managing perimenopausal symptoms. Here’s a summary of some that are commonly used:

• Maca: An adaptogen that may boost energy, increase libido, and manage symptoms like hot flashes
• Soy products: Soy products that contain a plant-based estrogen called isoflavones may ease perimenopausal symptoms
• Black Cohosh: Often used for hot flashes, mood swings, and sleep disturbances, but its effectiveness and safety require more research
• Red Clover: Contains isoflavones that may help with hot flashes and night sweats
• Dong Quai: Traditionally used for menopausal symptoms, but evidence of its effectiveness is limited
• Evening Primrose Oil: Sometimes used for menopausal symptoms, though research is mixed
• Ginseng May help with mood symptoms and sleep disturbances
• Chaste Tree (Vitex): Known for supporting PMS symptoms and may improve mood symptoms during perimenopause
• Flaxseed: A source of lignans, which may help balance hormones and alleviate mild menopausal symptoms
• St. John’s Wort: Used for mood changes, though it can interact with other medications
• Valerian Root: Sometimes used for sleep problems associated with menopause
• Vitamin B6: Helps produce serotonin, which can decline with age and contribute to mood changes. It may also help reduce PMS symptoms
• Vitamin B12: Recommended for older individuals to support cognitive function and reduce symptoms of brain fog
• Magnesium: Can help with cramps and pain, neurological symptoms such as sleep issues, mood changes, migraines, and heart palpitations
• Omega-3 Fatty Acids: Shown to ease psychological distress and depressive symptoms
• Vitamin D: Important for bone health and may help with hot flashes and vaginal dryness

Lifestyle changes can help manage perimenopausal symptoms. Some effective changes include:

• Temperature Regulation: Keep rooms cool, and carry a small fan to manage hot flashes.
• Dietary Adjustments: Avoid triggers like alcohol, caffeine, and spicy foods.
• Smoking Cessation: Quitting smoking can help alleviate symptoms.
• Regular Exercise: Engage in cardiovascular and weight-bearing exercises to maintain a healthy weight and improve overall health.
• Vitamin D and Calcium: Ensure adequate vitamin D and calcium intake for bone health.
• Stress Management: Practice relaxation techniques such as meditation, yoga, or tai chi to manage stress and improve sleep quality.

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Hypothyroidism is more common during perimenopause

According to research, hypothyroidism – both overt and subclinical –  is more prevalent during perimenopause and postmenopause compared to the time prior to perimenopause.

During perimenopause, a woman’s estrogen and progesterone levels start to decline, leading to irregular periods and other symptoms. This hormonal imbalance can also affect the thyroid gland’s ability to function properly, leading to hypothyroidism. The ovaries and thyroid gland have a complex relationship, and any disruption in one can impact the other.

Thyroid function should be regularly screened during perimenopause

Given the increased prevalence of thyroid dysfunction during perimenopause and the potential for changes in thyroid function during this time, regular thyroid function screening is crucial during this phase of life. The indications for measuring thyroid-stimulating hormone (TSH) in perimenopausal women should be broad rather than restrictive, given that both conditions have similar and overlapping symptoms.

The symptoms are similar

The symptoms of hypothyroidism and perimenopause can overlap, making it challenging for women to identify the root cause of their discomfort. The signs and symptoms of thyroid disorders can mimic those of perimenopause. These include fatigue, brain fog, forgetfulness, mood swings, weight gain, irregular menstrual cycles, and cold intolerance. This overlap can make distinguishing between the two conditions challenging, leading to potential misdiagnoses and insufficient treatment. Therefore, it’s crucial to screen women of perimenopausal age for thyroid dysfunction to ensure timely detection and proper treatment. Similarly, hypothyroid women in their 30s and above should consider the possibility that symptoms may be due to their perimenopausal transition.

It’s also important to recognize that worsening crossover symptoms may be a sign that you need a change in your thyroid treatment or better control over perimenopausal symptoms. Both can also be true simultaneously. It’s essential to communicate with your healthcare provider, who can conduct the assessments and recommend tests to help determine the source of your symptoms and how best to resolve them.  

Estrogen treatment can affect your thyroid levels and dosage requirements

If you’re taking both thyroid hormone replacement medication and estrogen, there are several potential issues to consider. Estrogen, especially in the form of oral tablets, can raise the levels of a protein called thyroid binding globulin (TBG), which can decrease the availability of thyroxine (T4). It can also affect the way your thyroid medication is absorbed, potentially requiring an adjustment in the dose of medication. On the other hand, transdermal estrogen, such as patches, gels, or sprays, does not affect TBG levels and may be suitable to take with thyroid medication.

Estrogen treatment can also affect the conversion of the inactive thyroid hormone (T4) into the body’s active form (T3). Suppose you’re receiving any form of estrogen treatment for your perimenopausal symptoms. In that case, you should monitor your thyroid function closely and consult with your healthcare providers to ensure optimal thyroid hormone levels are maintained.

Additionally, estrogen has indirect effects on how thyroid hormone is used and typically increases the need for thyroid hormone in hypothyroid women, requiring an increased dose of medication for many women. You must be aware of these potential interactions and work closely with your healthcare provider to monitor and adjust your medication as needed.

A healthy lifestyle before perimenopause can ease symptoms and support overall health

Incorporating several key healthy lifestyle factors can make perimenopause easier while supporting your thyroid – and overall – health. These factors include:

• Healthy Diet: Consuming whole foods, particularly vegetables, and avoiding junk food, refined sugars, and carbohydrates can help manage weight and support overall health.
• Regular Physical Activity: Daily exercise, including cardiovascular and strength training, can help control weight, improve heart health, maintain bone density, and manage stress, which can become more challenging during perimenopause.
• Stress Management: Developing an effective stress-reducing practice can help alleviate stress-related symptoms and support hormonal balance and overall well-being.
• Sleep Habits: Establishing good sleep habits and seeking ways to counter sleep-disrupting hormonal changes can support overall well-being during perimenopause.

By incorporating these lifestyle factors, you’ll be better prepared to manage the symptoms of perimenopause while supporting your thyroid and general health during this transitional phase.

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Women with hypothyroidism need to be aware of the potential impact of perimenopause on their condition. The increased prevalence of thyroid dysfunction during perimenopause, the overlap of symptoms between hypothyroidism and perimenopause, and the potential implications for the management of hypothyroidism all underscore the importance of regular thyroid function screening during this phase of life.

A note: you can simplify regular thyroid testing using the Paloma home thyroid test kit. This comprehensive test kit provides a complete overview of thyroid function by measuring not only Thyroid Stimulating Hormone (TSH) but also Free Triiodothyronine (fT3), Free Thyroxine (fT4), and TPO antibodies, which are essential for assessing thyroid health. The test is convenient, allowing you to test anywhere, and the results are typically available within a few days.

If you’re hypothyroid and in perimenopause, you’ll also benefit significantly from working with Paloma Health for your hypothyroidism care. Paloma Health offers a comprehensive approach that considers your needs and hormonal status. Through a combination of traditional medical care and a holistic and integrative approach that includes nutrition and lifestyle, Paloma Health provides tailored treatment options to address your symptoms and support your immune system and hormonal balance. By partnering with Paloma Health, you can benefit from personalized care and a better understanding of how to manage your hypothyroidism during the perimenopausal stage.