Weight gain, insomnia, digestive problems, fatigue. If you're a woman in your 40s or 50s, you may be wondering whether your symptoms are being caused by low thyroid function or perimenopause.
Perimenopause typically starts between ages 42 and 47 and ends the year after you achieve menopause (when your period stops). The average age for menopause is 51, with 5 to 7 years either side also being within what is considered 'normal'.
Once you're in your 40s, the signs of hypothyroidism might become harder to spot because they can be similar to the symptoms we view as normal in perimenopause. Perimenopause can mask a thyroid problem.
Our thyroid hormones are important for healthy functioning. The hormone produced by the thyroid gland has an effect on nearly every tissue in the body. Thyroid hormone is crucial for metabolic regulation which affects how the body makes energy. Adequate levels of T3 (the active form of thyroid hormone) affect heart rate, body temperature, brain and muscles, and govern how effective the body is at burning calories. You can check out the tables below for some common symptoms experienced by high or low thyroid function.
Hormonal changes can trigger thyroid dysfunction at any age, but there are some particular lifestages where women are at a greater risk. Studies show us that thyroid disease is more commonly triggered during puberty, pregnancy, perimenopause and when taking the oral contraceptive pill. A study of more than 50,000 Korean women over the age of 40 concluded that hypothyroidism is more prevalent in late perimenopause than in younger age groups.
We also know that men have a much lower risk of thyroid dysfunction because they don't experience reproductive hormone fluctuations like women do.
I have included 2 tables below to show the large overlap between symptoms of perimenopause and those of thyroid dysfunction. This means that subclinical hypothyroidism or hyperthyroidism can easily be overlooked during perimenopause.
The table below compares the overlap of symptoms in perimenopause and hypothyroid:
Perimenopause | Low thyroid function |
fatigue | fatigue |
changes in menstrual cycle | changes in menstrual cycle |
depression/low mood | depression/ low mood |
digestive changes - increased bloating | digestive changes - bloating and constipation |
slowed metabolism | weight gain |
dry skin, thinning hair | dry skin, hair loss |
pain or stiffness in joints | pain or stiffness in joints |
sleep changes | sleep changes |
forgetfulness, brain fog | memory changes, forgetfulness |
The second table compares the overlap of symptoms in perimenopause with common hyperthyroid symptoms:
Perimenopause | Thyroid over function |
fatigue | fatigue |
poor sleep | poor sleep |
anxiety | anxiety |
heart palpitations | heart palpitations |
hot flushes | heat sensitivity |
lack of focus and concentration | hyperactivity |
mood changes | mood changes |
If you're experiencing any of the above symptoms, it's important that you don't assume that it's just perimenopause. A thorough thyroid function test at this time can reduce the problems you experience as you transition through perimenopause.
Progesterone, estrogen, and thyroid hormones
When it comes to our hormones, it's all a delicate balancing act. Every gland in our endocrine system produces hormones that directly affect other glands, and other hormones.
In the early stage of perimenopause, progesterone levels begin to decline. Since progesterone assists with the conversion of T4 (inactive thyroid hormone) to T3 (our active thyroid hormone), low levels of progesterone can directly impact metabolism and energy levels.
Simply supplementing with progesterone is not always the answer, as sometimes supplementation can lead to more inactive thyroid hormone circulating. I like to start with a gentle herbal medicine, such as chaste tree, to increase your body's own production of progesterone, rather than supplementing. Diet and lifestyle changes can all assist your body's ability to produce progesterone.
Because progesterone levels are in decline during the early stage of perimenopause, this leaves estrogen unopposed, often triggering symptoms associated with higher estrogen such as heavy bleeding, migraines and histamine intolerance. Higher estrogen and histamine levels can then exacerbate symptoms of hypothyroidism.
Under active thyroid has been known to slow down liver detoxification of estrogen, worsening symptoms of estrogen dominance in the early stages of perimenopause. If you are experiencing migraines and/or heavy periods, then your estrogen levels are likely to be high and your thyroid function might be impacted.
In the late stage of perimenopause, estrogen levels also start to decline. Low estrogen levels can also impact the thyroid, by increasing hypothyroidism.
So you can see that both high estrogen levels and low estrogen levels can affect thyroid hormones. It's important to have regular check ups with your doctor during perimenopause to monitor any changes in thyroid stimulating hormone (TSH) that occurs with fluctuations in progesterone and estrogen.
Insomnia and exhaustion in perimenopause
Exhaustion is common in perimenopause due to lack of sleep. Low progesterone levels can increase wakefulness, especially in the week leading up to your period. Heightened anxiety can also contribute to poor sleep during this stage, with women describing that they lie awake thinking and worrying, often for up to 2 hours before being about to fall back to sleep. Additionally, lowering estrogen levels occurring in the late stage of perimenopause might cause hot flushes and sweating at night, making uninterrupted sleep difficult.
In hypothyroidism, the exhaustion is driven by low thyroid hormones, or low conversion of the inactive hormone, T4, into the active thyroid hormone T3. This hormone reduction will send your body a message to slow down the amount of energy available. Women with low levels of thyroid hormone often describe exhaustion and fatigue even if they are getting a full nights sleep. With hypothyroidism, you might need to take naps during the day just to manage your usual activity levels.
Fatigue is also a symptom of hyperthyroidism, where the thyroid gland is producing too much thyroid hormone. Your thyroid hormone sets the pace of your metabolism, so high levels can lead to a racing heart and feeling of exhaustion. An increase in thyroid hormone can also cause sleep problems and a feeling of anxiety, because your body wants to go, go, go.
If I am working with a perimenopausal women who is chronically exhausted, we must rule out thyroid problems while also supporting reproductive hormones.
Weight gain in perimenopause
In the later stage of perimenopause, weight gain is common because estrogen levels are no longer supporting insulin sensitivity. During this stage, it's common for women to report that they are eating the same food and doing the same exercise that they were previously, however they keep putting on weight. This weight gain of around 5kg tends to occur in the late 40s to early 50s. I have found that women often maintain their weight more easily on a lower carbohydrate diet during this stage. The weight gain can tend to land in places that you might not have carried weight before, such as your hips.
Low thyroid function can also contribute to weight gain. If your thyroid is under-functioning, it means that you might have less energy to exercise. If you're only just managing to get through each day, it can be harder to make good food and exercise choices, leading to weight gain. Couple this with an active/stressful work and home life, and it's easy to see why women put on weight during this life stage.
Hypothyroidism can impact your whole digestive system, slowing it down, so that you might experience bloating and constipation.
When I see weight gain in women during perimenopause, I like to investigate insulin, fasting glucose and thyroid function. In women younger than 40, I look to thyroid function, glucose metabolism and PCOS before considering perimenopause.
Depression in perimenopause
From my experience working with women in perimenopause, I find it more common for women in the early stages of perimenopause to suffer from anxiety, rather than depression. From my observations, depression tends to come during the lower estrogen, or later stage perimenopause.
So if a woman in her early 40s says that she's feeling depressed, especially if the depression is every day, and not just the week leading up to her period, this is a red flag for me to look more closely at thyroid function.
Natural thyroid support in perimenopause
Happily, when you choose natural treatments to support your thyroid function, you will also experience benefits in your perimenopause symptoms.
Do you suspect you're struggling with symptoms of low or high thyroid function, however your thyroid tests come back normal?
Here are some ideas to support yourself:
Test your levels of nutrients that support healthy thyroid and reproductive hormones. For example iodine, iron, zinc, vitamins D and B12. You may need to supplement with these nutrients if you diet is inadequate, and if you're unable to spend time in the sunshine. Check with your doctor, a naturopath, or nutritionist for support with this.
Move your body. Strength training builds muscle and supports metabolism. Exercise contributes positively to maintaining a healthy weight, sleep and mood during perimenopause.
Support your nutrition. Hormones are completely dependent on the foods we eat. Healthy hormones come from eating good quality proteins (beef, lamb, chicken, pork, fish and seafood, legumes, tofu and lentils); healthy fats (oily fish, avocado, nuts and seeds, good quality oils such as olive oil), and healthy carbohydrates (vegetables, fruit, whole grains, nuts and seeds).
Cortisol, your stress hormone, has a direct influence on progesterone levels and thyroid hormones. Managing stress levels is fundamental to healthy hormone balance. I recommend creating stress relieving rituals such as breathing techniques, mindfulness meditations, or yoga. If you are too busy or stressed out to implement these strategies into your life, then I recommend at a minimum, supporting your adrenal health with herbal medicine and nutrients.
Metabolism has many factors including, of course, diet, exercise and thyroid function. Managing your blood glucose levels will also be important at this time. Once again, you might like to test for fasting glucose and insulin levels. You may find that cutting back on gluten and processed foods has a positive impact on your metabolism.
Ensure adequate sleep. Although this is the sixth point in this list, arguably a good nights sleep is the basis of great health and happy hormones. Healthy sleep routines including not exercising just before bed, paying attention to circadian rhythms by going to bed around 10pm and waking around 6 to 7am, and turning off all your devices at least an hour before you plan to sleep. If sleep is a problem for you, I recommend employing a good bedtime routine and trying herbal medicine or herbal tea.
Address gut health. Getting to the bottom of digestive problems can be a game changer for thyroid conditions, especially if there are autoimmune thyroid antibodies. Leaky gut, gut dysbiosis and histamine intolerance can be linked to autoimmune thyroid condition Hashimoto's disease. If you regularly suffer from constipation or bloating, then addressing gut health might be a priority for you.
Reduce toxin exposure. There are chemicals in our environment that can affect the functioning of our endocrine glands, including the thyroid. I recommend limiting your exposure to unnecessary chemicals in your home and food, which might mean switching to more natural cleaning products, and buying organic foods whenever you can afford to.
I hope you have found this blog helpful. If you would like some more help with perimenopause, your thyroid health, or both, there are 2 ways to work with me:
Enrol in my perimenopause coaching program called THRIVE
or
Book in for a consultation
I would love to assist you in navigating a smooth transition through perimenopause and feel like you can thrive during this time, not just survive!
Simone :)
Hi! I'm Simone Jeffries. I am a naturopath, nutritionist, herbalist and certified wellness coach. I am also a foodie and an advocate for a whole food diet.
I love to support you with hormonal conditions, histamine intolerance and vaginal imbalances.
I welcome clients to consult with me at my clinic in Manly on Sydney's Northern Beaches, and online from anywhere in Australia.
The information in this blog is from my Bachelor of Health Science degree, experience from working with women in my clinic, and continuing research.
This blog is for information only and not intended to take the place of medical advice. Please seek assistance for any medical concerns.