I'd be interested in hearing you discuss hashimoto’s and thyroid medication during perimenopause and menopause, and/or how those hormones can affect your thyroid and the way your body absorbs thyroid medicine. I'm 51 with Hashimotos, Armour Thyroid (90mcg), with levels considered normal by the endocrinologist.
I am gluten and dairy free and eating well. But I still struggle with constipation, weight gain, insomnia, facial puffiness etc--hypothyroid symptoms. In November I had the first period that I have had in about 8 months. In the weeks after that, everything seemed to be in good working order...lost the weight, digestion was great, puffiness went away. Now a few months later (with no periods), all those same symptoms are returning.
I had been on Armour from June until I saw the endo in November . I saw the endo on 11/19 and my TSH was 4.6, Free T4 0.81 (those are the only ones they gave me and there isn't a patient portal where I can peek at others that might have been taken).
They advised me to go up to 90mcg at that time as he likes the TSH lower. The period that I had was on 11/13 and so when I saw him everything was going GREAT...had dropped 6 pounds without trying, sleeping well, digestion good. Have been on 90mcg since November and am creeping steadily upwards, digestion sluggish, insomnia, etc. Ahhh!
Thanks for your question Michelle- it is quite likely there are hundreds of thousands of women in your shoes. Before I forget to mention it- work with your doctor to at minimum add in a Free T3 test. TPO and TgAb antibodies tests and Reverse T3 would also be helpful.
This is a complicated issue and I can give you some good general information but as with everything- we are all bio individual so you will have to experiment to find what works for you.
Women start to make less estrogen and progesterone as we near our 40’s. This alone can trigger our thyroid to slow down. It sounds like you might be on a hormonal roller coaster here which is totally possible as you approach menopause.
I like seeing that your endocrinologist likes to see your TSH lower than 4.6. Ideally it should be around 1-2. But upping your medication might not be the solution. That is not to say you shouldn’t take it as prescribed- I’m just saying there might be things you can do that will allow you to take a dose and stay there without having these fluctuations like you are.
You say you are eating clean and gluten and dairy free. That sounds good, but what does clean eating mean to you?
How much sugar or starchy foods are you eating? Once we hit a certain age, those starchy carbohydrates can be a problem for some of us when we are looking to maintain or lose weight.
Those of us with hypothyroidism whether caused by Hashimoto’s disease or not can encounter issues with insulin resistance. Our body cannot process and tolerate sugars like it used to- my body certainly can’t. This means that you will have to be very mindful of what you are putting in to your body and even what time of day you do it.
Maybe you feel tired an hour after eating lunch- even a paleo style lunch. If it had some starches in it, and you are feeling tired- like a sugar crash- then you likely are not tolerating starchy carbs at that time of day.
If you struggle with sleeping- falling asleep or staying asleep a bit of starch in the evening meal might help you sleep better. The only way to know is to try it for a couple of days.
Let’s talk about what perimenopause and menopause are before we dive in to what might be happening with you.
During perimenopause (the 2-12 years before you reach menopause)
It can start in your late 30’s but is more commonly occurring in your 40’s. You can have hot flashes, sleep problems, mood swings, and heavier than normal periods (this part is the worst if you ask me) and these symptoms can wax and wane for a good 10 years.
Your estrogen during perimenopause will be fluctuating significantly to the point that you will have more than you’ve ever had circulating through your body at some times and other times it might be low. It is much like the blood sugar roller coaster but is called the perimenopause roller coaster.
heavy flow that is new to you or longer flow (high estrogen)
cycles that are less than 25 days long
changes in breast tissue: lumps, sore, swollen (high estrogen)
waking in the middle of the night and you didn’t before
worse or more cramping
start of night sweats, especially before a period (low estrogen)
migraines that are new to you or are worse
mood swings before a period (high estrogen)
gaining weight without changing what you are doing
You may have some or none of these symptoms. About 20% of us will have dramatic changes during perimenopause. The rest of us are lucky to have minor issues.
Progesterone is gradually lost during this time which is kind of like a cruel joke from mother nature because it is the progesterone that helps counteract the affects of estrogen.
It also helps us deal with stress and the loss of progesterone makes us feel more anxious, depressed and have poor quality sleep.
Managing your diet and allowing some self care.
Don’t kill yourself in the gym- over exercising or doing too intense of a workout will affect your energy levels for days to come, especially if your adrenal glands are worn out or confused about what to do for you
Learn to let stuff go- like dishes and cleaning the house.
Avoid alcohol- this alone can wreak havoc on your hormones at this stage in the game. It keeps us from getting rid of that excess estrogen AND lowers progesterone.
Manage your blood sugar. Journal your food so you can see just how much starchy food and sugary foods you might be eating.
Take magnesium- it calms our brain, helps us sleep and regulates our brain communication with our body
Exercise gently, especially if you are dealing with Hashimoto’s. Autoimmune Strong is a great place to start.
If you are dealing with heavy bleeding, you need to avoid dairy which Michelle already is, avoid alcohol, eat fermented foods and lots of veggies to help keep your gut bacteria healthy. Gut bacteria clear estrogen from your body and so does fiber so eating more veggies than you already are can be really helpful. I also find my energy to be better when I eat more veggies- like 7-8 servings or more a day.
If your hypothyroidism is not being managed well (meaning your TSH and free T3 are not optimal) then you may have heavier periods as well. Work to get your TSH around 1-2 and some doctors think it is okay if it is a little below one (.3 to .5)— especially if you are on a natural desiccated thyroid hormone replacement- When T3 is optimal you might find a suppressed TSH. Finding a doctor that will allow your labs to look this way is another story.
Also keep in mind that you might feel great at a TSH of 2 and someone else might feel good at .3. This is bio individuality. It is so important to know your body and learn how to tell when things are off.
Your thyroid medication may need to be adjusted seasonally too. If you live in a climate with winter- even all for seasons then your TSH may rise in winter and fall during summer. Another reason to really be in tune with your body and its signals.
Part of my job as a Nutritional Therapy Practitioner is to help you learn how to do this.
Menopause starts one year after your last period and symptoms should be better.
You will have much less estrogen and progesterone at this point. Your adrenal glands will be making estradiol in your cells and this is supposed to be enough to keep you feeling good. BUT- if your adrenals were taxed for years before this happens then you may have some issues.
Your endocrine system is made up of the pineal and pituitary glands in your brain, the thyroid and parathyroid glands, the Thymus (works with the immune system), Adrenals glands, pancreas and your ovaries. All of these work synergistically together as a system and when one is off, they will all be off.
You can’t just take a supplement for your adrenals and think that it will fix your issues. It will help in the short term but it is a band-aid and not getting at the root cause of your problem.
If you have gained weight around your middle, you are more than likely dealing with insulin resistance. This means that your cells are not accepting glucose or sugar from insulin as it travels through your blood stream to bring your cells sugar. Your liver and your muscle cells are not accepting the sugar so it just stays in your blood stream and eventually gets transported to fat tissue for storage. This is why we gain weight.
The best way to combat this is to quit sugar completely. No dessert, no sweet anything. Every time you eat sweets it makes your insulin resistance worse. Even fruit- so keep your natural sugars to below 25 grams of fructose
High fructose corn syrup in soft drinks is 55% fructose, sugar cane is 50% fructose and honey is 40% fructose. Eight ounces of orange juice has 18 grams of fructose. So pay attention to what you are eating. If it is sweet tasting, it is likely contributing to your weight at this point.
Starchy foods like potatoes and rice are mostly glucose and very little fructose but you might find you still have a problem with those as well and will need to test your carb tolerance with a glucose monitor. Start with sugar though. It is more important at this stage to remove sugar from your diet and then look at the starches.
Hormone fluctuations during perimenopause and menopause can affect how your thyroid functions.
You might end up with estrogen dominance (the highs on the rollercoaster) which can keep thyroid hormone from attaching or making their way into the receptors on your cells. This means your cells are not getting thyroid hormone creating hypothyroid symptoms.
Thyroid hormones are similar in chemical make up to estrogen. Too much estrogen or eating too much soy can block the receptor sites as well leaving you with less thyroid hormone in your cells and hypothyroid symptoms.
As we lose our progesterone, we may see or feel a need for more thyroid hormone. We need progesterone to get T3 which is what our cells use and need.
Our thyroid naturally slows down as we get older and therefore will not be able to get enough hormone to our cells affecting not only our energy but creating all the other symptoms we have talked about before.
If you are dealing with chronic stress, and most of us are, this will also affect our ability to make enough thyroid hormone.
When your thyroid is not working optimally or you are not medicated optimally, all of your hormones will be disrupted.
It will be important to know if you are in menopause or if you’re having a thyroid problem. If you take estrogen thinking you are in perimenopause or menopause and it is actually your thyroid causing the problems, you might end up feeling worse and the estrogen will affect your thyroid function. Vicious cycle as with so many things in our body. One can’t work well without the other.
If you have crazy periods during your 30’s and 40’s it is more likely an issue with thyroid than perimenopause. Thyroid problems are often the cause of early perimenopause. I’m a textbook example of this.
They make the symptoms of perimenopause and menopause worse, affect blood sugar, make you depressed, affect your ability to handle stress.
You have options:
start with journaling your food to pinpoint
are you eating enough
are you eating too much sugar
is your ratio of protein fats and carbohydrates where it should be
are you eating a lot of processed foods or a whole foods diet?
reduces hot flashes
lessens depression, less anxiety
higher sex drive
sleep is better
lowers insulin resistance
increases bone density
helps manage weight
natural supplements- introduce 1 at a time and wait 2-3 weeks before adding another one
will help your hormones adapt and balance as needed
can reduce hot flashes
supports the entire endocrine system, including adrenals and thyroid
can regulate menstrual cycles
can increase energy and stamina
don’t take it if you are on estrogen
soy- is supposed to be helpful as a phytoestrogen to help with menopausal symptoms. I’m not sure how I feel about this. Don’t supplement but get it in food form. I would go for tempeh and miso and NOT genetically modified.
helps to reduce hot flashes
helps insomnia, fatigue, anxiety, depression
helps with joint pain/body aches
Damiana- tea or tincture (2-3 ml 2 to 3x/day)
helpful for hot flashes, low sex drive and general well being
hot flashes, insomnia, fatigue, anxiety
helps regulate endocrine system
Chasteberry or Vitex
helpful for breast tenderness
headaches, irritability, depression, fatigue
Supplements suggested can be bought through this trusted source (my fullscript store)