How Thyroid Disease and Menopause Are Connected

A Q and A with Drs. Richard and Karilee Shames

older woman

We know the benefits of estrogen were long overplayed, and risks of hormone replacement therapy were minimized. Thyroid, menopause, and estrogen have a complicated relationship.

I spoke with  Drs. Richard and Karilee Shames, authors of Thyroid Power, about estrogen replacement therapy.

Q: What is your concern about the thyroid/menopause connection?

Perhaps the biggest potential for mischief in the whole thyroid field is in the arena of women’s health and menopause.

Everything from minor vaginal irritations to repeated miscarriages have been shown to be thyroid-related in a certain percentage of sufferers. Menopause is not an illness, but it can sure begin to feel that way if your thyroid is low or borderline at the time of your change.

Women in this frustrating circumstance are often told "It's just your menopause," as if they should expect to feel awful for years because of a natural reduction in estrogen. The ovaries and uterus need proper amounts of thyroid hormone as much as any other organ or system.

Despite increased awareness in the medical community about the issues and interventions surrounding menopause, tremendous numbers of women still suffer from menopausal difficulties. Frequently, neither the synthetic nor the natural hormones provides complete relief.

This is often because the underlying problem is undiagnosed low thyroid. By age 50, one in every twelve women has a significant degree of hypothyroidism.

By age 60, it is one woman out of every six.

This runaway thyroid epidemic seems to be striking menopausal women harder than any other group of patients. Fortunately, much can be done to help them.

Q. What can help menopausal women with thyroid issues?

For symptomatic menopausal women not wanting or benefiting from estrogen, we advocate thyroid blood testing first, perhaps followed by a clinical trial of thyroid hormone, even if their blood tests are in the normal range.

Frequently the underlying hypothyroidism is such a controlling factor that simply correcting it returns the whole system to fairly normal functioning. Menopause continues, but it is a more mild, gradual, and comfortable process. If your thyroid is low, your hot flashes will be much more pronounced, much more frequent, and more disconcerting. This is because thyroid is your energy throttle, your gas pedal. You need energy to go through the change gracefully.

How much energy people have, how well they get up in the morning, how well they sleep, and how much stamina they have for the day is directly related to their levels of thyroid hormone. When your level is too low, you don’t have the energy to cope adequately with anything, much less the additional stress and emotional liability associated with the menopausal years.

Consider the following case. Just the other day we were doing one of our long-distance telephone consultations with a 51-year-old schoolteacher from the midwest, named Sarah.

Both she and her mother started menopause at what would be considered an early age of 46. Sarah knew that her mother had low thyroid, as well as severe menopause problems. Neither the mother, nor Sarah, nor their doctors connected these two situations. When Sarah herself began to have the same severe menopause problems as her mother, she accepted it as her genetic predisposition. She was sometimes so hot and sweaty during a school day that she would need to keep a change of clothes in the teachers’ lounge. Needless to say, the kids got on her nerves easily, and she was not enjoying her previously satisfying job.

Fortunately, she was referred to our office by her school principal, who was our patient. Sarah’s previously normal TSH was now, with advancing menopause, 6.2, clearly in the abnormal range. It indicated that her thyroid hormone levels were not keeping up with the extra demands of her changing metabolism.

Once on thyroid medication, she began to feel like her old self in a matter of weeks. Her menopause symptoms faded into the background, and her life became more balanced and enjoyable.  Thyroid hormone alone resolved the problems.

Q. What other menopausal symptoms may respond to thyroid treatment?

Atrophic vaginitis, or thinning of the vaginal wall as the result of falling estrogen levels, can lead to itching, discharge, and painful intercourse. All of these symptoms are much more severe when your thyroid is low.

Women who have had unremitting vaginal dryness that was unresolved with vaginal creams or estrogen pills are often found to be low thyroid, if checked carefully. In addition to getting an important part of their intimate life back, once treated with thyroid medicine, these women are pleased to find that their problems with dry hair, dry skin, and cracking nails are often resolved as well.

We don’t intend to belittle the persistent difficulty that some women have at this time in their life. Not everyone will be helped as quickly or as completely as was Sarah. The dance of the hormones is very complex, so the idea that you can take just one hormone, or even two, and experience total relief, is not always borne out successfully. You need to look at the whole picture. That’s what we mean by holistic health.

Q. What do you recommend for women in their forties and fifties?

Try to take into account all of your hormones, not just one of them. In fact, you can use this multifactorial approach to assess all aspects of your life when trying to solve a thorny problem. If you are dissatisfied with your relationship or your job, these could be crucial aspects of your return to a less symptomatic menopause. Many women find that more than medical intervention is needed. Some find that quiet time away from their life stressors works wonders. Another reason to look beyond simple estrogen replacement is the fact that estrogen is not always a friendly and helpful substance.

Optimizing your thyroid can be a far better way to achieve the smoother menopause and the preventive health care you may desire.

Richard Shames MD is a Harvard and University of Pennsylvania educated General Practitioner with over 30 years of experience. He is presently practicing in San Rafael, CA. He & Karilee Shames PhD, RN, co-authored the HarperCollins book ThyroidPower.

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