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Hypothyroidism and menopause - how hormonal imbalance affects the thyroid

Most women agree that menopause is accompanied by profound changes on both emotional and physical levels. This transition and the years leading up to it, known as perimenopause, can cause the body to temporarily shift its balance while hormones recalibrate and readjust to a new set of demands. With childbearing over, the body intelligently conserves energy and slows production of reproductive hormones. In many cases, progesterone is the first to decline, which temporarily leaves estrogen as the dominant hormone.

Some researchers and practitioners feel that an imbalance between estrogen and progesterone (often called “estrogen dominance”) is a key factor in decreased thyroid function. The combination of normal estrogen levels with decreased progesterone may block the action of the thyroid hormone and lead to symptoms of hypothyroidism, even as thyroid hormone levels appear normal on lab results.

Most women agree that menopause is accompanied by profound changes on both emotional and physical levels. This transition and the years leading up to it, known as perimenopause, can cause the body to temporarily shift its balance while hormones recalibrate and readjust to a new set of demands. With childbearing over, the body intelligently conserves energy and slows production of reproductive hormones. In many cases, progesterone is the first to decline, which temporarily leaves estrogen as the dominant hormone.

Hormonal imbalance contributes to perimenopausal and menopausal thyroid problems, but I’ve found that there are additional factors to consider as well. The bodies’ systems are intimately connected, and a disease or disorder may not always begin with the tissue or organ exhibiting the problem. And a disorder in the thyroid may very well originate somewhere else in the body. Let’s begin with how the adrenal glands influence thyroid function.

How your adrenals can affect your thyroid function

In patients with symptoms of hypothyroidism, after thyroid testing it is important to evaluate their adrenal function. Many women are surprised to learn there’s a connection between the two (that is, if they’ve even heard of the adrenals!) But I’ve found overstressed adrenal glands to be one of the most common contributors to hypothyroidism in my patients.

Stress of any kind — mental, emotional, or physical — stimulates the hypothalamic-pituitary-adrenal (HPA) axis, the dynamic feedback system between the brain and the adrenal glands. Overstimulation of this axis has huge implications throughout the body.

The short-term result of a stimulated HPA axis is higher cortisol production from the adrenals. High cortisol (hypercortisolism) in the bloodstream can directly inhibit production of TSH (thyroid-stimulating hormone) as well as conversion of T4 to T3. But cortisol can’t remain high forever. Eventually, the adrenal glands reach exhaustion and too little cortisol is produced (known as hypocortisolism), which comes with another set of problems.

Either way, with lower levels of T3 in the blood, your cells can’t produce a healthy biological response. This is when women begin to see hypothyroidism symptoms like fatigue, cold intolerance, weight gain, memory loss, poor concentration, depression, infertility, hair loss and more.

The prescription drug levothyroxine acts by replacing the body’s T4 with a synthetic form. Though some women feel better on some form of levothyroxine, many do not. When overstressed adrenals are at the root of your thyroid trouble, feeding the body more T4 is a stop-gap solution that eventually teaches the thyroid to stop producing its own T4. If you’re not already on synthetic T4, it may be worthwhile finding out why thyroid function declined in the first place — an important step toward correcting it.

The adrenal glands are one piece to the thyroid equation, but for other patients, there may be something entirely different causing a sluggish thyroid. My experience has shown me that looking deeper into the origins of a thyroid disorder can be much more helpful in bringing TSH down, while at the same time creating whole-body wellness.

Other factors in the hypothyroidism equation

On top of the physical and emotional stress women feel at menopause, there are several very real biological stresses on the thyroid to consider.

Low iodine levels. 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 the eggs! We need about one milligram of iodine a week to form the required amount of thyroxine.

But iodine is not all that widely distributed in nature. Despite iodine being added to our commercial table salt, American iodine status was recently deemed “marginal” by the World Health Organization. Given that many of the world’s crop-growing soils lack iodine, fewer people eat foods naturally rich in iodine, and more and more avoid iodized table salt, iodine deficiency is on the rise.

Exposure to environmental toxins — including halides, heavy metals, pesticides, and antibiotics in our air, food, and water — can also interfere with our thyroid function. We all know it’s best to limit our toxic exposure wherever possible, but increasing iodine intake and implementing a regular detox program to support the body’s natural detoxification pathways can also make a difference.

Food allergies and sensitivities — including to gluten — can place tremendous stress on thyroid function. Many of my patients with hypothyroidism see positive results when they eliminate gluten from their diets. You, too, may want to give an elimination diet a try. This is a connection I’ve noticed for several years, and research around the world is bearing this out.

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