Menopause is the transition from reproductive to non-reproductive phase which refers to the natural part of the aging and is a normal life stage of every woman. However, there is a large individual variation and each woman experiences menopause in a different way. One woman may go smoothly through these hormonal changes, while another can suffer with many debilitating symptoms until she receives proper treatment.
Stages of menopause
Perimenopause is a transitional period from a normal to completely absent ovarian function. During this time ovarian function becomes erratic with fluctuations in estrogen levels that results in some physical symptoms such as hot flashes, night sweats, headaches, mood swings and irregular periods. Perimenopause usually begins when a woman is in her 40s and lasts as long as four to eleven years.
During perimenopause the ovaries start to decrease their ovulatory function. The majority of women do not notice the menopause onset until they reach the last few years of perimenopause when estrogen production drops more quickly and dramatically.
Menopause begins when the ovaries stop to release eggs and a woman no longer has periods. Menopause usually occurs between the ages of 45 and 55 with an average age of 51 in the US. A general indication of menopause is cessation of periods for 12 consecutive months.
The postmenopausal time is divided into two stages:
- Early postmenopause is within the first five years since the last menstrual period. At this stage hormone therapy is initiated if the symptoms, osteoporosis and bone loss become severe.
- Late postmenopause is five years and beyond.
Who is more likely to experience the symptoms of menopause:
- Women with personal or family history of breast or ovarian cancer
- Women who have blood clots
- Women with personal or family history of hormonal abnormalities and adrenal issues
- Women with thyroid problems and autoimmune diseases
- Women who have early menopause
- Women with surgical removal of the ovaries, after chemo- or radiation therapy
Factors affecting menopause
It is not well understood why the age of the menopause onset varies form woman to woman. Many environmental and lifestyle factors such as the use of oral contraceptives and smoking are related to the beginning of the natural menopause.
Genetics determines the number of eggs in the woman’s ovaries and the age when she goes into menopause. A strong association between genetics and the onset of the menopause were found based on the studies of the menopausal age of mothers, daughters and between siblings. If the women in your family went into menopause around 50, chances are 30 to 85% that you will experience menopause around this time also.
Smokers and women with chronic illness, autoimmune diseases, surgical removal of the ovaries or damage to the ovaries from the chemotherapy or radiation therapy are more likely to experience an early menopause. On average smokers reach the menopause two years earlier than non-smokers.
Premature menopause is characterized by the absence of normal ovarian functions and occurs in less than 1% of women under the age of 40 and 0.1% before the age of 30. Clinical diagnosis of early menopause is based on the absence of periods for at least 4 months in combination with FSH levels exceeding 40 IU/L before age of 40. However, about half of the patients show intermittent estrogen production and could ovulate making pregnancy possible after a diagnosis is made.
Women with Hashimoto’s disease are at a higher risk to develop another autoimmune disease. Premature ovarian failure or oophoritis is a painless autoimmune inflammation of the ovaries resulting in early menopause before age forty with a loss of fertility and ovary hormonal functions. The incidence of premature ovarian failure of the autoimmune origin is higher in women with Hashimoto’s disease. However, the diagnosis does not automatically means that a woman cannot get pregnant. About half of the patients show intermittent estrogen production and could ovulate that can lead to a pregnancy even after the diagnosis have been made.
Thyroid and menopause connection
It is challenging to define the hormone related symptoms of menopause from those caused by aging, environmental stressors or other diseases. Low-grade hypothyroidism and Hashimoto’s disease in women around 50 can be confused with symptoms of perimenopause and menopause. The thyroid disease diagnosis is frequently missed and can lead to a lack of proper treatment and also make menopausal symptoms worse.
Hormonal changes during perimenopause and menopause can interfere with thyroid function in two ways:
1. There is a sharp increase in the incidence of autoimmune condition called Hashimoto’s disease in women approaching menopause mainly due to over stimulation of the immune system by an excess amount of estrogen in those who have low levels of progesterone.
At Hashimoto’s, high thyroid antibodies are one of indicators of active autoimmune attack on the thyroid gland that can result in the gland destruction and release of an excessive amount of thyroid hormones into the bloodstream. During this temporary events called hashitoxicosis a woman can experience typical hyperthyroid symptoms such as hot flashes, heat intolerance and insomnia that can be easily mistaken for symptoms of menopause.
2. During perimenopause progesterone declines faster than estrogen resulting in condition called estrogen dominance. Many women have low progesterone levels even before they develop estrogen deficiency. Estrogen dominance suppresses the thyroid leading to hypothyroid symptoms, while progesterone supports thyroid function.
These are some common symptoms that can be related to both menopause and hypothyroidism making the diagnosis more difficult:
1. Weight gain.
At hypothyroidism, insufficient amounts of thyroid hormone slow down the metabolism and affect the way the body processes proteins, fats and carbohydrates leading to weight gain and water retention.
Hormonal changes during perimenopause and menopause often result in increased body fat accumulation. Estrogen unopposed by enough progesterone contributes to both:
- Suppression of the thyroid function which results in weight gain and hypothyroid symptoms.
- Insulin resistance which prevents the sugar to enter into the cells leading to high blood sugar and depriving the cells of the energy they need to function. This is the main reason why so many women with insulin resistance experience carbohydrate cravings, fatigue and weight-gain.
2. Depression and mood swings.
Rapid and abrupt drop in hormones increases the chances of extreme mood disturbances in women. Studies show that estrogen (estradiol) and progesterone can be helpful in alleviating the mild perimenopausal and menopausal depression. Furthermore, mood swings, low energy and inability to concentrate that have failed to respond to estradiol alone may improve with the addition of testosterone.
Thyroid can cause depression in women. In hypothyroid patients depression is mostly associated with low levels of vitamin D, low thyroid hormone T3 and/or thyroid hormone resistance. Correction of these imbalances has shown to be helpful in alleviating depression and significantly improves the mood.
3. Low energy, fatigue and insomnia.
During perimenopause and menopause fatigue is usually caused by interrupted sleep due to hot flashes, night sweats and other disturbances triggered by hormonal changes. Once the hormones stabilize, sleep pattern and energy levels return to normal.
Thyroid hormone affects the neurotransmitter balance and the conversion of serotonin to melatonin pathways that regulates sleep. Moreover, many women with thyroid problems have issues with their adrenal glands:
- High cortisol at night time due to stress or disturbances in circadian rhythm prevents release of melatonin causing difficulty in falling asleep.
- If the adrenal glands are weak it produces sub-optimal levels of cortisol. Women wake up in the middle of the night because there is not enough cortisol to stimulate glucose release stored in the liver to supply the brain. Using sleep aids either do not work or make the situation worse because brain cells are starving for glucose.
Adrenal function can be checked using 24 hours cortisol saliva test. It is the best test to determine if you have adrenal insufficiency or disturbances of cortisol rhythm because it measures your cortisol on the tissue or cellular level. The saliva samples are taken 4 times during the day in order to determine whether low cortisol levels may be responsible for sleep problems and fatigue that you may experience during particular times of the day.
In addition to adrenal insufficiency other abnormalities such as low blood sugar, anemia and nutritional factors can also be an underlying cause of insomnia, low energy and persistent fatigue. All these conditions are often created by imbalanced diet and as a complications of hypothyroidism and Hashimoto’s disease. It can be helped with an appropriate thyroid treatment and holistic nutrition.
How do you know if it is menopause or your thyroid?
Before starting hormone therapy for menopausal symptoms, thyroid function should be checked in every woman to avoid missing the diagnosis of hypothyroidism, Hashimoto’s disease and prescriptions for unnecessary hormone medication.
Conventional medicine relies only on the TSH and T4 thyroid hormone tests in the diagnosis of hypothyroidism dismissing the symptoms if the results of the lab tests are in the normal range. The best approach to find the underlying cause of your health problems is to evaluate the symptoms together with results of the thyroid and hormone tests:
- If you are tired all the time, feel cold, gain weight without changing your diet and have a swollen or enlarged thyroid gland you are most likely to have thyroid issues.
- If you have temporary events when you experience hot flashes and are cold right after it, gain weight especially around midsection and wake up at night having night sweats, your symptoms are more likely to be caused by hormonal imbalances attributed to perimenopause or menopause.
Comprehensive thyroid blood tests can help to diagnose Hashimoto’s disease and hypothyroidism. A special test for Thyroid Binding Globulin (TGB) can help to identify if suppressed thyroid function is caused due to high estrogen in comparison to progesterone levels. In this case use of thyroid medication is not justified and balancing female hormones can restore thyroid function and relieve both thyroid and menopausal symptoms.
Combined with hormone testing the results can indicate if changes in estrogen, progesterone, testosterone and DHEA levels during peri- and menopause affect the thyroid function and cause hypothyroid symptoms. True Health Labs recently introduced easy and affordable testing for menopause and a comprehensive perimenopause test.
How to prevent and relieve menopause symptoms
There is a big debate happening in the medical society regarding hormone replacement therapy, however at the same time hardly anybody is talking about all other crucial aspects that affect woman’s body when she goes through peri- and menopause. In fact, a proper diet and healthy adrenal glands are more important that the hormone replacement for minimizing the symptoms.
In young women major hormones are produced mostly in the ovaries and in less quantities by the adrenal glands. During perimenopause and menopause, when the hormones start to fall, then the adrenals become the back up for the hormone secretion.
Your adrenal glands are your best defense against hormonal imbalances and menopause symptoms. When hormones start to fluctuate in a healthy woman who has strong adrenal glands, the adrenals take over a woman’s estrogen production and she will have an easy transition during the menopause without symptoms. In those who have adrenal exhaustion estrogen starts to fluctuate due to a failure of adrenal glands to produce missing hormones.
If you have weak adrenals or adrenal insufficiency, most likely you will experience more severe menopausal symptoms. Women with autoimmune disease, Hashimoto’s and thyroid issues often have adrenal insufficiency due to excessive stress to the body which is trying to adapt to the chronic condition.
Other endocrine glands such as adrenals and sympathetic nervous system overwork trying to compensate for slow metabolism caused by suboptimal levels of the thyroid hormones and battling an inflammation due to to autoimmune disease. The majority of patients experience persistent fatigue and some sort of physical weakness most of the time. However, some women can temporarily have a rapid heart rate, feel hyperactive, jittery and restless before progressing into the phase of adrenal exhaustion and fatigue.
A good diet is the foundation of hormonal balance and healthy adrenal glands. It not only makes you feel good but it can also positively affect your thyroid, adrenals and minimize the menopausal symptoms by supporting the hormonal pathways. Avoid hormonal disruptors in the foods such as antibiotics and hormones in the meats and poultry, pesticides in fruits and vegetables and other chemicals in the cleaning supplies.
Using bio-identical hormone therapy can help with menopausal symptoms. However, hormones are very potent substances and especially in the cream form can cause serious imbalances due to bypassing the natural regulatory mechanisms of the body. Most women can achieve relief of menopausal symptoms by supporting their adrenal and thyroid function, stabilizing blood sugar, focusing on the gut health and using high quality essential acids.
In the following video Naturopathic physician Dr. Holly Lucille talks about her approach to treat menopause and help women to go through this transition smoothly and how to prevent desease development due to hormonal imbalances:
If you would like to restore your hormonal levels and improve peri- and menopausal symptoms focus on your thyroid first. Optimal hypothyroidism and Hashimoto’s treatment will automatically improve the production of many other hormones. Learn more here
P.S. Do you like what you read? Subscribe to the Outsmart Disease thyroid blog updates and get your FREE e-mail course Nutritional guide for Hashimoto’s disease
The menopause thyroid solution: Overcome menopause by solving your hidden thyroid problems by M.J. Shomon, Harper Paperbacks, 2009
The wisdom of menopause: Creating physical and emotional health during the change by Dr. Christiane Northrup, Bantam, 2012
What you must know about women’s hormones: Your guide to natural hormone treatents for PMS, Menopause, Osteoporosis, PCOS, and more by Dr. P.Wartian Smith, Square One Publishers, 2009
What your doctor may not tell you about menopause: The breakthrough book on natural hormone balance by Dr. R.Lee, V.Hopkins, Grand Central Publishing, 2004
What your doctor may not tell you about premenopause: Balance your hormones and your life from thirty to fifty by Dr. R.Lee, V.Hopkins, Grand Central Publishing, 2005
Dr. John Lee’s hormone balance made simple: The essential how-to guide to symptoms, dosage, timing, and more Dr. R.Lee, V.Hopkins,Grand Central Life and Style, 2006
Menopause before 40: Coping with premature ovarian failure by K.Banerd, Your Health Press, 2006
Sex hormones and mood in the perimenopause. Ann N Y Acad Sci. 2009 Oct;1179:70-85.
Ovarian aging: mechanisms and clinical consequences. Endocr Rev. 2009 Aug;30(5):465-93.
Premature menopause or early menopause: long-term health consequences. Maturitas. 2010 Feb;65(2):161-6.