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Menopause or Low Thyroid -- Is it One, the Other or Both?

Many are told they are just perimenopausal and should start supplementing estrogen. Things aren't always cut and dry, however, and simply prescribing estrogen replacement without a deep exploration into the patient's metabolism and chemistry doesn't work.
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As women approach their late 30s into their 40s and 50s, changes occur that can produce a myriad of symptoms. Perimenopause is the transition from fertility to menopause ushering in the end of menstruation and ability to conceive a child.

During this phase of life, women often experience symptoms like mood swings, irregular heart beat, depression, loss of libido, hair loss, decreased memory, extreme fatigue, irregular periods, changes in body temperature, constipation and weight gain. Readers out there may be thinking that all of these symptoms sound very familiar. That's because they are almost identical to those of low thyroid.

Hypothyroidism is a condition that increases in frequency as people age into their 40s and 50s. While it does affect men, the majority of low thyroid cases are women in their peri and menopausal years.

Frequently, patients will complain of an array of symptoms such as those described above. Many are told they are just perimenopausal and should start supplementing estrogen.

Things aren't always cut and dry, however, and simply prescribing estrogen replacement without a deep exploration into the patient's metabolism and chemistry doesn't work. For some, estrogen may actually inflame the situation.

Hypothyroidism is often overlooked in these patients. When it is checked, the majority of routine TSH testing fails to detect the problem so it can go undiagnosed and untreated. Hypothyroidism and menopause are intricately interwoven and need to be teased apart for proper treatment.

Is it perimenopause, or is it low thyroid?

The sex hormones estrogen and progesterone are normally produced in quantities that balance each other and keep things in check. As a woman ages, her egg supply begins to dwindle as well as the quality of the eggs that are available. This results in a decreased demand for sex hormones so ovaries produce less with age.

As hormone levels begin to change, estrogen and progesterone proportions can be knocked out of sync. In the earliest stage of perimenopause, progesterone levels are often the first to drop causing women to have more estrogen. This imbalance, called estrogen dominance, may produce symptoms identical to those associated with low thyroid. Additional symptoms like vaginal dryness, bloating and tender breasts may also occur.

If that wasn't enough, excess estrogen left unchecked by progesterone, can interfere with the action of thyroid hormone. In these cases, even if the thyroid is able to produce enough hormone to keep up with the metabolic needs of the body, it will not have an effect and cells will experience a hypothyroid state.

This cause and effect is a two-way street. Low thyroid function leads to decreased levels of progesterone. This will have the same result creating an imbalance in hormones with higher levels of estrogen. Besides producing uncomfortable, even debilitating symptoms, excess estrogen is toxic and may lead to more serious conditions like migraines, fibroids, ovarian cysts, breast, uterine and ovarian cancer.

Hypothyroidism has reached epidemic proportions affecting many more people than previously suspected. While the American Thyroid Association estimates 1 in 8 women will develop a thyroid condition in her lifetime, clinical observation points to numbers that are much higher. Getting properly tested, diagnosed and precisely treated is important for hormonal health and the well being of your entire body.

Get tested.

I often write about the importance of adequate thyroid testing, but it can't be stressed enough. Thyroid hormone affects every single cell, tissue and process in the body so getting properly diagnosed is essential to good health. It's too important to rely solely on the routine TSH test, which, unfortunately fails to pick up on a majority of low thyroid cases. There are many conditions that create falsely low TSH levels on testing which will mask low thyroid conditions. Getting properly evaluated will not only empower you to take control of your health, it will arm your medical doctor with all of the necessary information needed to correct underlying imbalances and heal from the bottom up.

The first step should be to find a doctor who offers comprehensive thyroid testing. A full panel should include at a minimum, levels of thyroid hormones free and total T3 and free and total T4 and TSH. Reverse T3 will give an indication as to how your body is activating thyroid hormone and reacting to inflammation in your body. One of the most important and often overlooked tests checks for antibody levels of TPO, TGAb and TSI. Autoimmunity is the No. 1 cause of low thyroid so knowing your antibody levels will give important information to your doctor.

Optimally find a doctor who offers TRH testing. The TRH stimulation test can often catch cases of low thyroid that are otherwise invisible on routine testing-sometimes even with a full panel. Additionally I find it to be the most accurate way to monitor treatment for those that need thyroid hormone replacement. Many patients who are fortunate enough to actually be correctly diagnosed through routine testing don't feel better once treatment has begun. The TRH can help ensure precise dosage and types of hormone are used.


One of the liver's important roles is to metabolize and detoxify sex hormones especially the estrogen hormones. A few steps can ensure your liver is up to the task.

  • Maintaining levels of B6, B12 and methyl folate will help with a process called methylation. This is a necessary step to excrete estrogen from the body.

  • Foods rich in sulfur such as egg yolk, garlic, onion and Brussels sprouts will also aid in the detoxification of estrogens.
  • Glutathione is the major cellular antioxidant of the body. Additionally it helps prepare estrogens to be excreted. Walnuts, asparagus and avocado are rich sources of glutathione. Talking the supplement N-acetyl cysteine can also boost levels.
  • Milk thistle and dandelion support liver function and increase bile production
  • Avoid excessive alcohol and unnecessary drugs.
  • Eat a diet that limits processed and high fat foods while including lots of fiber.
  • Hormone replacement therapy.

    While many doctors prescribe estrogen supplements for their perimenopausal patients, they may be doing more harm than good. As we have seen, for many patients, estrogen may wind up being too high before it becomes low. In these cases, topical progesterone cream may help to restore balance and lessen symptoms.