You’ve no doubt heard horror stories about the symptoms that may come with perimenopause, the transitional period leading to menopause. But the problems can be far more complex. As if hot flushes, night sweats, insomnia, loss of libido, weight gain and brain fog weren’t enough, you can also develop hypothyroidism ― that is, an underactive thyroid.
It happens to around 26% of women undergoing perimenopause.
Why is hypothyroidism so bad?
For starters, if you have low thyroid function, there’s a good chance you will also find yourself battling depression.
Not only that, but when this little butterfly-shaped gland at the base of your throat malfunctions, it can have huge repercussions for your entire body.
The thyroid produces triiodothyronine (T3) and a larger amount of thyroxine (T4), which is converted to T3. These two hormones affect metabolism. That means they control how your body uses food to produce energy and determine the rate at which your heart, liver, muscles and other organs, including your brain, work. In short, they affect about all your body’s working parts.
One of the most common effects of low thyroid ― when not enough thyroid hormones are being produced or when they’re not working at the cellular level ― is depression.
Why Do Perimenopausal Women Get Hypothyroidism?
Perimenopause occurs in mid-life, normally beginning between your mid-30s and late 40s. That’s the same time when your risk for hypothyroidism greatly increases, so it’s entirely possible that the two simply occur coincidentally.
But it’s equally true that perimenopause and hypothyroidism are often related. As your egg supply diminishes with the onset of perimenopause, your ovaries begin to produce less oestrogen. However, your progesterone level can fall far faster than that of oestrogen, throwing these two hormones out of balance. In other words, your optimal oestrogen/progesterone ratio is disrupted.
This imbalance often results in oestrogen dominance ― a condition when progesterone falls to a level so low that it’s unable to limit the action of oestrogen. When this happens, you can experience symptoms exactly like those caused by low thyroid, including depression, along with weight gain and brain fog.
But it can get worse . . . .
All that low but excessive oestrogen can actually sabotage your thyroid hormones. Even if your thyroid is pumping out sufficient T3 and T4, oestrogen dominance can make them ineffective. And if they can’t do their job, you will develop hypothyroidism.
It can also work the other way. A pre-existing low-functioning thyroid can cause your progesterone levels to plummet. Even if your oestrogen/progesterone balance was initially optimal, the ultimate result can be oestrogen dominance, which further impairs the thyroid and worsens depression.
How Hypothyroidism Leads to Depression
The T3 thyroid hormone acts in the brain to govern three neurotransmitters important to your emotions:
- Serotonin: Optimal levels of serotonin (called the “feel-good” neurotransmitter) make you feel happy and relaxed
- Norepinephrine: Improves mood, helps you deal with stress and acts like a natural anti-depressant
- GABA (gamma aminobutyric acid): Improves mood and relieves anxiety
When the action of the T3 hormone is impeded by hypothyroidism, these mood-stabilising neurotransmitters are effectively taken ‘off-line.’ When that happens, depression gets worse.
Serotonin seems particularly important for maintaining an ‘up’ attitude and good mood, but it can drop precipitously following an abrupt decrease in oestrogen, which can occur in the mid-30s. Shortages of serotonin can worsen symptoms associated with menopause ― hot flushes, insomnia and mood changes ― that can add significantly to depression.
How You Can Relieve Thyroid Dysfunction and Depression in Perimenopause
Diagnosing low thyroid can be tricky. Even though your oestrogen/progesterone levels are unbalanced and affecting your thyroid hormones’ action, a routine thyroid test may show your thyroid hormones are at perfectly normal levels. That’s because your thyroid is putting out hormones that can be measured ― they just can’t do what they’re supposed to do.
Generally speaking, adequate thyroid treatment will reverse thyroid hormone insufficiency and depression. It’s important to be aware, however, that people with hypothyroidism-induced depression are often misdiagnosed and treated as having a psychiatric illness. As a result, they are frequently prescribed antidepressants.
Unfortunately, antidepressants can be addictive. Also, they can have dangerous side effects. They can, in fact, actually worsen depression ― even trigger homicidal or suicidal impulses ― and they won’t fix an oestrogen-dominance problem or a low-thyroid problem.
To reverse low thyroid and depression during perimenopause, you will need thyroid testing, but the standard TSH test doesn’t detect most cases of low thyroid and won’t give you the answers you need.
You need a restorative medicine physician skilled in bioidentical hormone restorative therapy (BHRT) who offers comprehensive, full-panel thyroid testing. That includes total T3 (TT3) and total T4 (TT4) tests, along with a TSH test. He or she will also do full testing of your sex hormones (oestrogen, progesterone and testosterone) in order to assess their status.
With that knowledge, your doctor will prescribe the appropriate treatment to restore optimal balance to your hormones, proper functioning to your thyroid, and a life free of perimenopausal-related depression, as well as other troubling menopausal symptoms.
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Kellman, R. Menopause or Low Thyroid ― Is It One, The Other or Both? Huffington Post, THE BLOG. Oct. 30, 2015.
Magnolia. 35 Symptoms of Perimenopause ― Hypothyroidism. The Perimenopause Blog. Oct. 10, 2016.
Northrup, C. Thyroid Disease. DrNorthrup.com.
Perimenopause and Thyroid Problems ― common and confusing. CEMCOR.