If you are a woman in your forties or fifties and you are exhausted, having trouble losing weight, worried about hair loss, or struggling with brain fog, you may assume that your symptoms are related to your hormones. And you would be right. But do you know which hormones are at the root of your symptoms? Let’s look at the changes in progesterone and estrogen that accompany your perimenopause and menopause, and changes in thyroid hormone levels, and the confusing challenges that these hormonal shifts can cause.
What are perimenopause and menopause?
Perimenopause is defined as the time of hormonal changes before you stop having menstrual periods.
During perimenopause, your supply of egg follicles — stored in your ovaries — decline and the follicles that remain are harder to stimulate. As a result, levels of follicle stimulating hormone (FSH) rise, to help stimulate your follicles to ovulate and release an egg.
Follicle stimulation and ovulation require sufficient levels of estrogen and progesterone, and these hormones start to decline. If they are unable to stimulate ovulation, you will have an anovulatory cycle, where no egg is released. This can trigger both early menstrual periods or shorter menstrual cycles. Because estrogen and progesterone can fluctuate unpredictably, your menstrual cycle can also become unpredictable. During those cycles when an egg is released normally, your cycle may appear normal.
Perimenopause can begin as early as 10 years before periods actually stop, and frequently starts in your late thirties or early forties.
When your supply of eggs is exhausted, and ovulation stops entirely, menstrual periods stop.
Menopause is officially defined as the point at which it has been a full year since you have had a menstrual period. The average age of menopause for American women is 51, though menopause from 48 to 55 is considered normal. Premature menopause is defined as menopause before the age of 40.
Signs and symptoms of perimenopause and menopause
The most obvious clinical sign of perimenopause is a change to your menstrual cycle, including:
- Erratic menstrual cycles, including shorter, more frequent menstrual periods
- Skipped periods
- Phantom periods (when you have symptoms of a period, but no bleeding)
- Heavier menstrual flow
- More clots in your menstrual flow
Note: It’s important to have any irregular bleeding during perimenopause evaluated, to rule out pregnancy, fibroids, or cancer. All bleeding after menopause must be evaluated right away by your physician.
Because you have more anovulatory cycles, your ability to become pregnant also drops significantly during perimenopause. When pregnancy occurs, the risk of miscarriage is also much higher. At the same time, because of hormonal changes, you may notice a welcome reduction in premenstrual syndrome symptoms such as bloating, cramps, and backaches.
Perhaps the best-known symptoms associated with perimenopause and menopause are hot flashes and night sweats. Some women have hot flashes and night sweats throughout perimenopause, while others may develop these symptoms around the time their periods stop. Some women do not experience these “flashes” as heat, but instead, have short bursts of an elevated heart rate and/or anxiety.
Some other signs of perimenopause include:
- Increased FSH levels, increases in luteinizing hormone (LH), a hormone that helps prepare eggs for ovulation
- Drops in estradiol and progesterone levels
- Shrinking, sagging, and a reduction in the firmness of breasts
- An increase in breast lumpiness
- Increased breast tenderness
- Increased vaginal dryness and irritation
- Increased urinary tract and vaginal infections
- Urine leakage and stress incontinence
- Sleep problems, including difficulty falling asleep and/or staying asleep
- Difficulty losing weight
- Redistribution of weight from hips and thighs to the abdominal area
- Changes in mood, including increased anxiety, depression, rapid changes in your mood, and difficulty dealing with stress
- A reduction or loss of sex drive, less lubrication before and during sex
- Hair changes, including male-pattern balding at the hairline, thinning hair, hair loss, and slowed hair growth
- Thinner, dryer, itchier skin
- More wrinkles
- Onset of adult acne
- Heart palpitations
- Reduced bone density
- Brain fog, and difficulties with concentration and memory
Perimenopause, menopause, and your thyroid
There are a two key challengesperimenopause, menopause, and your thyroid pose to your health.
First, thyroid disease is more likely to develop during periods of hormonal change and as we age, making perimenopause and menopause a key time for thyroid problems to show up in women.
Second, most of the signs and symptoms of perimenopause/menopause are also the same as the signs and symptoms of thyroid problems. Thyroid problems can cause menstrual irregularities, dry skin, hair loss, loss of sex drive, fatigue, weight changes, bone density changes, brain fog, sleep problems, mood changes, and even hot flashes. This makes it more difficult to determine the underlying cause of the symptoms.
These two challenges can have a negative impact on your health:
- If your symptoms are actually caused by an undiagnosed/untreated thyroid problem, you may be misdiagnosed as (peri)menopausal, and resulting treatment will not resolve your symptoms.
- If you are a thyroid patient and your symptoms are caused by (peri)menopausal hormonal shifts, your doctor may simply adjust your thyroid dose, which will not resolve your symptoms.
Is it perimenopause/menopause, your thyroid…or both?
If you are experiencing these symptoms, what steps should you follow to get your health back on track?
If you already have a thyroid condition: Make sure that your thyroid treatment is optimized before you suffer from chronic perimenopause/menopause symptoms, or go the route or prescription hormone replacement therapy (HRT). Optimal thyroid treatment means that your TSH, free T4, and free T3 levels are not borderline high or low and that your treatment includes T3 hormone if you need it to relieve symptoms.
If you have symptoms, but you don’t know if you have a thyroid problem or perimenopausal/menopausal changes, or both: Start witha comprehensive clinical thyroid examination, and an evaluation, including TSH, free T4, free T3, and thyroid antibodies blood testing. If you have any thyroid imbalances, experts recommend that you address them before pursuing prescription HRT to treat (peri)menopausal symptoms.
If your thyroid is healthy or optimized: Your next step is to work with a practitioner to evaluate and address your hormonal status.
Keep in mind that some of the providers who may be best able to help balance your hormones during perimenopause/menopause include Certified Menopause Practitioners (CMPs), gynecologists, nurse practitioners, and integrative/holistic physicians. You can find a CMP at the North American Menopause Society’s “Find a Menopause Practitioner” online database.
An evaluation would likely include a clinical and pelvic exam, FSH, estrogen, and progesterone testing, and a review of your medical history and symptoms. Once you and your practitioner have identified your specific imbalances, you can work to develop a plan to address your symptoms with vitamins, herbs, botanicals, lifestyle changes, nutritional changes, and prescription HRT if needed.
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Mary Shomon is a thyroid disease, hormonal and autoimmune health writer, and patient advocate. For two decades, Mary has been a leading force advocating for more effective, patient-centered thyroid and hormonal health care. Mary is the New York Times bestselling author of “The Thyroid Diet Revolution,” “Your Healthy Pregnancy with Thyroid Disease,” “Living Well With Hypothyroidism,” and 10 other books on thyroid disease and integrative health. She co-stars in two PBS health specials, “Healthy Hormones,” and “Vibrant for Life.” Follow her on Twitter at @thyroidmary or at her Facebook communities: ThyroidSupport and ThyroidDiet.