Hypothyroidism in perimenopause and menopause

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Hypothyroidism in perimenopause and menopause

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by Marcy Holmes, NP, Certified Menopause Clinician, and Marcelle Pick,

OB/GYN NP

Over 20% of menopausal women in the U.S. are diagnosed with thyroid

dysfunction. Recent studies suggest that millions more suffer from

subclinical problems but are undiagnosed. Notably, women are far more likely

than men to be afflicted.

The great majority of these women suffer from hypothyroidism - a sluggish

thyroid - which leads to fatigue, weight gain, depression, high cholesterol

and other symptoms. A fraction suffer from hyperthyroidism, which is an

overactive thyroid.

What accounts for this epidemic of thyroid dysfunction? And what should you

do about it? Before answering these questions, let's remember that the

thyroid can't be viewed in isolation from the rest of your endocrine system.

On the contrary, it sits at the very center of the action. And it is just as

vulnerable to stress and lack of support as every other part of your body.

Understanding how those stresses create illness and disease will also show

us how to create balance and wellness.

What does the thyroid actually do? Located behind the Adam's apple, the

thyroid controls the rate of function of every cell and gland of the body,

including growth, repair and metabolism. Its hormones affect the chemistry

of the brain, playing a key role in mental function, moods and emotions. It

greatly influences the activity of the sex hormones, which in turn affect

thyroid function.

What are the symptoms of hypothyroidism? An under-active thyroid may cause

fatigue, weight gain, depression, muscle aches, joint pain, loss of mental

clarity and function, dry skin, brittle hair, hair loss, breast milk

formation, constipation, a constant feeling of being cold, and many other

symptoms.

Subclinical hypothyroidism may present itself with mild versions of these

symptoms, or often just fatigue or depression. Hypothyroidism is also

clearly associated with elevated levels of LDL, the " bad " cholesterol, and a

heightened risk of heart disease.

In some cases, hypothyroidism leads to a goiter, an enlargement of the

thyroid sufficient to be noticeable. The gland enlarges to try and produce

more. Hyperthyroidism may also cause a goiter, as the gland enlarges in

response to attacks by antibodies.

It's important to note that without treatment or relief of the underlying

causes, the symptoms of hypothyroidism will generally worsen over time,

resulting eventually in permanent damage.

What triggers hypothyroidism? Thyroid dysfunction develops more often during

pregnancy, perimenopause and menopause than at other times, suggesting that

fluctuations in hormone levels act as triggers.

Dr. Lee has long argued that an excess of estrogen combined with low

progesterone - the " estrogen dominance " typical of early perimenopause - is

also a major trigger. Strong synthetic estrogens, such as those in Premarin,

may exacerbate estrogen dominance.

Dr. Lee argues that curbing estrogen dominance prevents many problems in

perimenopause, including hypothyroidism. Supplemental progesterone can

offset estrogen dominance, but women taking prescription-strength estrogen

will generally need prescription-strength progesterone as well.

How do I know how well my thyroid is functioning? Testing for thyroid

function has become controversial. For many years the conventional approach

was to measure the pituitary gland's stimulation of the thyroid, or Thyroid

Stimulating Hormone ( " TSH " ). The theory was that high levels of TSH indicate

the thyroid is sluggish and needs a push from the master gland to get its

job done.

In this simple approach, the range considered " normal " for TSH can be quite

wide (0.5-5.0). Within the " normal " range many practitioners won't diagnose

a problem, even if your thyroid actually is struggling. Outside this range

many practitioners will prescribe a one-size-fits-all prescription for a

synthetic thyroid supplement.

We use the TSH test mostly as a screener. We consider it ideal when a woman

reports she is thriving and her TSH is less than 2.0. If she reports

symptoms, or a higher TSH level, she may have subclinical hypothyroidism. We

would evaluate several forms of intervention (discussed below) to push the

thyroid to heal and function more optimally. If medication was indicated we

would adjust dosages according to test results and other factors. In our

experience this personalized approach yields better outcomes.

For women with more pronounced symptoms, we feel that the TSH test is

inadequate because it doesn't tell us enough about the underlying problem.

To do that, we need more detailed tests to show what the thyroid is

producing and what is available for the body to use.

The predominant product of the thyroid is T4 (Thyroxine), which is then

converted by the liver into the usable form T3 (Triiodothyronine). There are

many causes of inadequate T4 production, including adrenal stress, poor

nutrition and autoimmune thyroid disease. Similarly, many factors cause

inadequate conversion of T4 into T3, including lack of adequate nutrients

and minerals and poor liver function.

There are tests now that provide a complete picture of how well the thyroid

produces T4, how much of the active form T3 is created, how well the body

converts and uses the T3, and if there are significant antibodies present.

In our clinical practice we use the " Comprehensive Thyroid Assessment " blood

panel from Great Smokies Diagnostic Laboratory (www.gsdl.com). We highly

recommend this panel; you can ask if your practitioner is familiar with it,

or find a practitioner who is.

A skilled practitioner also learns a great deal from a woman's medical

history and physical examination, especially skin, eyes, hair, energy level,

bowel habits, and body temperature.

Is it really just a thyroid problem? In many cases the thyroid problem is

itself a symptom of something else. Adrenal stress, for example, impairs

thyroid function. Cortisol blocks the efficient conversion and peripheral

cellular use of the thyroid hormones at many levels. For this reason we

evaluate and if appropriate test for adrenal function in combination with

thyroid testing.

Similarly, insulin resistance presents many of the same symptoms as

hypothyroidism, is often found to co-exist with it, and may play a role in

contributing to its development. Insulin resistance is itself tied to poor

nutrition, which impairs thyroid function.

Testing saliva or blood Progesterone levels during the luteal phase of the

menstrual cycle may also be of great value, so that gentle replacement can

be implemented if needed to reduce the negative impact of excess estrogen on

the thyroid.

How do you treat hypothyroidism? This too is the subject of recent debate.

What your health care provider chooses to do is a function of training and

experience. Most practitioners just prescribe synthetic T4 (Synthroid,

Levoxyl or Levothyroid) for hypothyroidism. But that works only if the

patient has no difficulty converting T4 into T3. For women who are poor

converters, synthetic T3 (Cytomel) is sometimes added to improve low T3

levels and their related symptoms.

Not every practitioner believes in using T3 since it is very short-acting,

somewhat a matter of trial and error, and difficult to monitor. There is

also desiccated thyroid taken from pigs (Armour Thyroid), which provides

both T4 & T3. Armour was the most common form of replacement until the 1970

s, when practitioners abandoned it for synthetic T4, under the argument that

a synthetic version was healthier because it was produced in a laboratory.

It is still available and often yields excellent results. The overall goal

with either formula should be to tailor dosage to symptom relief, achieving

levels of TSH less than 2.0 as well as optimal levels of T3 and T4.

What about natural alternatives? Alternative practitioners try to resolve

the underlying causes of poor health. In our experience, we can often

reverse suboptimal thyroid functioning well before a woman develops

permanent dysfunction. Success in this largely depends on how early we

intervene and on the degree of autoimmune antibodies (if any) that are

present.

Poor nutrition is probably the origin of many thyroid problems, and rich

nutrition is vital to reversing them, or at least to prevent further decline

Healthy thyroid function is dependent on a range of nutrients, especially

selenium, folic acid, and iodine. A medical-grade supplement (such as our

Essential Nutrients) is therefore vital. Of course, supplements should be

used to complement, not substitute for, a balanced diet.

Stress in all its forms is another key culprit. Most of us experience a high

degree of the most damaging kind - unremitting stress. We often see the

symptoms of hypothyroidism

totally reversed when a woman commits to a program that supports balance

through nutrition and daily self-care.

It's important to zero in on unresolved emotional issues as a source of

stress. In naturopathic medicine, the thyroid reflects a woman's voice in

her life. Many women have experienced a " trapped voice " , and by the time

perimenopause arrives the accumulated effect gives rise to symptoms,

including poor thyroid function. As Dr. Christiane Northrup has written,

menopause pushes women to find their voice and start using it. Over and over

we have seen that when women make progress in using their voices, their

thyroid symptoms subside.

Lastly, many women with hypothyroidism respond well to homeopathic remedies,

Chinese medicine, herbal support and acupuncture. However, in our experience

the nutritional, stress and emotional factors must be dealt with directly.

Our Personal Program is a great option. The Program supports healthy

endocrine function during perimenopause and menopause with nutritional

supplements, Natural Progesterone Cream and dietary guidance (the plan we

use was devised by a noted endocrinologist). This support can be vital

whether you are on or trying to avoid thyroid medication.

To learn more about the Personal Program, click here >>

To check out what other symptoms you may have, take our online Hormonal

Health Profile.

For further reading about thyroid health in perimenopause and menopause, we

recommend:

" The Wisdom of Menopause " by Christian Northrup MD

" The Thyroid Solution " by Ridha Arem MD