Perimenopause and Hashimoto’s Thyroiditis

hashimotos and perimenopause


Hormones are amazing things aren’t they. I mean really, they are! They are wonderful little chemical messengers that do all sorts of vital jobs, like telling us when we’re hungry or full, controlling our body temperature and metabolism, and they conduct the whole orchestra of events that is our fertility. Truly wonderous stuff.

Hashimoto’s Thyroiditis

As we know, with the autoimmune disease Hashimoto’s Thyroiditis, our normal hormone function becomes dysregulated. Under the misguided attack of our over stimulated immune system, our thyroid can no longer regulate the? hormones in the way we need it too. Most commonly with Hashimoto’s, the thyroid is putting out relatively low levels of the hormone T4, despite the pituitary gland sending lots of the hormone TSH telling it that we need more T4! Due to this the availability of the active hormone T3 is also low and as a result we find ourselves struggling with occurrences that other people’s thyroids regulate quite happily for them, such as weight gain, low energy levels, low mood, diminished libido, etc.

Due to the attack of our immune system on our thyroid, the thyroid becomes inflamed and damaged, meaning it is unable to regulate its production of T4 adequately. This may also be exacerbated by low absorption of nutrients due to poor gut health (which commonly goes hand in hand with autoimmune conditions) which are required by the body to produce T4 and convert to T3. At this stage medication is usually prescribed, and for those that find medication alone doesn’t resolve their symptoms, diet and lifestyle changes can often make a big difference in the quality of life of a person with Hashimoto’s.

Hashi’s and Perimenopause

So what happens when a disease state of hormone dysregulation, i.e. Hashi’s, meets a completely natural and normal event of hormonal fluctuation, such as perimenopause? Well, partly it depends on the individual and how sensitive they are to the hormonal fluctuations they are experiencing (and for this we can find clues by looking at the experience of close female relatives of perimenopause). But for those that are finding it tricky to navigate the onset of perimenopause alongside Hashi’s, it’s really no big surprise if we look at what’s going on.

Our Second Adolescence

With the onset of perimenopause, progesterone starts to decrease. Progesterone is the relaxer, the calmer, the mood lifter and the immune system modulator. Oestrogen begins to fluctuate, sometimes greatly, and this brings hot flushes, insomnia, night sweats, weight gain and headaches. As well as these symptoms, the spikes of oestrogen impede the conversion of T4 to it’s active T3 form, meaning that even if you’ve had previously well managed thyroid hormone levels, perimenopause is a time that is likely to throw those levels out. And due to the spikes and dips of oestrogen the effects will not be consistent.

So it makes sense that this hormonal rollercoaster (also seen during adolescence and pregnancy) often brings with it a flare of Hashi’s symptoms, the combination of which is known as “Thyropause” (and I must thank Lara Briden – women’s hormones whisperer – for introducing me to this term!).

How to Address the Cause and Symptoms of Thyropause

There are many ways that this hormone storm can be addressed through diet and lifestyle, and these are my go-tos:

  • Gut health
  • Liver support
  • Reduce inflammation
  • Targeted supplements
  • Relaxation
  • Sleep optimisation

The wonderful thing about this multifaced approach (that is different in practice for each person, as we all have our individual needs, wants and requirements) is that it addresses more than one element of dysregulation. For example, working on gut health improves oestrogen clearance, which goes some way to resolve the discomfort of the spikes and dips of perimenopausal oestrogen. It will also help manage bloating, balance mood, and improve sleep. How do we work on gut health? It really depends on the individual and their current health status.

What To Do Now

If you’ve been experiencing these symptoms of the hashis / perimenopause clash thinking it’s “normal” and it’s just something you have to suffer through, you’re wrong. Yes it’s common, yes your mum or aunt or big sister may have experienced a similar thing, but you don’t have to. Get in touch with a naturopath or nutritionist who can help manage these symptoms and guide you through perimenopause so you feel rejuvenated and excited for the second phase of your life. Get back in charge of your health!