Perimenopause and menopause with thyroid issues. Episode 33.

I'd be interested in hearing you discuss hashimoto’s and thyroid medication during perimenopause and menopause, and/or how those hormones can affect your thyroid and the way your body absorbs thyroid medicine. I'm 51 with Hashimotos, Armour Thyroid (90mcg), with levels considered normal by the endocrinologist. 

I am gluten and dairy free and eating well. But I still struggle with constipation, weight gain, insomnia, facial puffiness etc--hypothyroid symptoms. In November I had the first period that I have had in about 8 months. In the weeks after that, everything seemed to be in good working order...lost the weight, digestion was great, puffiness went away. Now a few months later (with no periods), all those same symptoms are returning.

I had been on Armour from June until I saw the endo in November .  I saw the endo on 11/19 and my TSH was 4.6, Free T4 0.81 (those are the only ones they gave me and there isn't a patient portal where I can peek at others that might have been taken).  

They advised me to go up to 90mcg at that time as he likes the TSH lower.  The period that I had was on 11/13 and so when I saw him everything was going GREAT...had dropped 6 pounds without trying, sleeping well, digestion good.  Have been on 90mcg since November and am creeping steadily upwards, digestion sluggish, insomnia, etc.  Ahhh!

Michelle. 

Thanks for your question Michelle- it is quite likely there are hundreds of thousands of women in your shoes. Before I forget to mention it- work with your doctor to at minimum add in a Free T3 test. TPO and TgAb antibodies tests and Reverse T3 would also be helpful. 

This is a complicated issue and I can give you some good general information but as with everything- we are all bio individual so you will have to experiment to find what works for you. 

Women start to make less estrogen and progesterone as we near our 40’s. This alone can trigger our thyroid to slow down. It sounds like you might be on a hormonal roller coaster here which is totally possible as you approach menopause. 

I like seeing that your endocrinologist likes to see your TSH lower than 4.6. Ideally it should be around 1-2. But upping your medication might not be the solution. That is not to say you shouldn’t take it as prescribed- I’m just saying there might be things you can do that will allow you to take a dose and stay there without having these fluctuations like you are. 

You say you are eating clean and gluten and dairy free. That sounds good, but what does clean eating mean to you? 

How much sugar or starchy foods are you eating? Once we hit a certain age, those starchy carbohydrates can be a problem for some of us when we are looking to maintain or lose weight. 

Those of us with hypothyroidism whether caused by Hashimoto’s disease or not can encounter issues with insulin resistance. Our body cannot process and tolerate sugars like it used to- my body certainly can’t. This means that you will have to be very mindful of what you are putting in to your body and even what time of day you do it. 

Maybe you feel tired an hour after eating lunch- even a paleo style lunch. If it had some starches in it, and you are feeling tired- like a sugar crash- then you likely are not tolerating starchy carbs at that time of day. 

If you struggle with sleeping- falling asleep or staying asleep a bit of starch in the evening meal might help you sleep better. The only way to know is to try it for a couple of days. 

Let’s talk about what perimenopause and menopause are before we dive in to what might be happening with you. 

During perimenopause (the 2-12 years before you reach menopause) 

It can start in your late 30’s but is more commonly occurring in your 40’s. You can have hot flashes, sleep problems, mood swings, and heavier than normal periods (this part is the worst if you ask me) and these symptoms can wax and wane for a good 10 years. 

Your estrogen during perimenopause will be fluctuating significantly to the point that you will have more than you’ve ever had circulating through your body at some times and other times it might be low. It is much like the blood sugar roller coaster but is called the perimenopause roller coaster. 

Symptoms include: 

• heavy flow that is new to you or longer flow (high estrogen)

• cycles that are less than 25 days long

• changes in breast tissue: lumps, sore, swollen (high estrogen)

• waking in the middle of the night and you didn’t before

• worse or more cramping

• start of night sweats, especially before a period (low estrogen)

• migraines that are new to you or are worse

• mood swings before a period (high estrogen)

• gaining weight without changing what you are doing

You may have some or none of these symptoms. About 20% of us will have dramatic changes during perimenopause. The rest of us are lucky to have minor issues. 

Progesterone is gradually lost during this time which is kind of like a cruel joke from mother nature because it is the progesterone that helps counteract the affects of estrogen. 

It also helps us deal with stress and the loss of progesterone makes us feel more anxious, depressed and have poor quality sleep. 

Managing your diet and allowing some self care. 

• Don’t kill yourself in the gym- over exercising or doing too intense of a workout will affect your energy levels for days to come, especially if your adrenal glands are worn out or confused about what to do for you

• Learn to let stuff go- like dishes and cleaning the house. 

• Avoid alcohol- this alone can wreak havoc on your hormones at this stage in the game. It keeps us from getting rid of that excess estrogen AND lowers progesterone.

• Manage your blood sugar. Journal your food so you can see just how much starchy food and sugary foods you might be eating. 

• Take magnesium- it calms our brain, helps us sleep and regulates our brain communication with our body

• Exercise gently, especially if you are dealing with Hashimoto’s. Autoimmune Strong is a great place to start. 

If you are dealing with heavy bleeding, you need to avoid dairy which Michelle already is, avoid alcohol, eat fermented foods and lots of veggies to help keep your gut bacteria healthy. Gut bacteria clear estrogen from your body and so does fiber so eating more veggies than you already are can be really helpful. I also find my energy to be better when I eat more veggies- like 7-8 servings or more a day.  

If your hypothyroidism is not being managed well (meaning your TSH and free T3 are not optimal)  then you may have heavier periods as well. Work to get your TSH around 1-2 and some doctors think it is okay if it is a little below one (.3 to .5)— especially if you are on a natural desiccated thyroid hormone replacement- When T3 is optimal you might find a suppressed TSH. Finding a doctor that will allow your labs to look this way is another story. 

Also keep in mind that you might feel great at a TSH of 2 and someone else might feel good at .3. This is bio individuality. It is so important to know your body and learn how to tell when things are off. 

Your thyroid medication may need to be adjusted seasonally too. If you live in a climate with winter- even all for seasons then your TSH may rise in winter and fall during summer. Another reason to really be in tune with your body and its signals. 

Part of my job as a Nutritional Therapy Practitioner is to help you learn how to do this. 

Menopause starts one year after your last period and symptoms should be better. 

You will have much less estrogen and progesterone at this point. Your adrenal glands will be making estradiol in your cells and this is supposed to be enough to keep you feeling good. BUT- if your adrenals were taxed for years before this happens then you may have some issues. 

Your endocrine system is made up of the pineal and pituitary glands in your brain, the thyroid and parathyroid glands, the Thymus (works with the immune system), Adrenals glands, pancreas and your ovaries. All of these work synergistically together as a system and when one is off, they will all be off. 

You can’t just take a supplement for your adrenals and think that it will fix your issues. It will help in the short term but it is a band-aid and not getting at the root cause of your problem. 

If you have gained weight around your middle, you are more than likely dealing with insulin resistance. This means that your cells are not accepting glucose or sugar from insulin as it travels through your blood stream to bring your cells sugar. Your liver and your muscle cells are not accepting the sugar so it just stays in your blood stream and eventually gets transported to fat tissue for storage. This is why we gain weight.  

The best way to combat this is to quit sugar completely. No dessert, no sweet anything. Every time you eat sweets it makes your insulin resistance worse. Even fruit- so keep your natural sugars to below 25 grams of fructose

High fructose corn syrup in soft drinks is 55% fructose, sugar cane is 50% fructose and honey is 40% fructose. Eight ounces of orange juice has 18 grams of fructose.  So pay attention to what you are eating. If it is sweet tasting, it is likely contributing to your weight at this point. 

Starchy foods like potatoes and rice are mostly glucose and very little fructose but you might find you still have a problem with those as well and will need to test your carb tolerance with a glucose monitor. Start with sugar though. It is more important at this stage to remove sugar from your diet and then look at the starches. 

Hormone fluctuations during perimenopause and menopause can affect how your thyroid functions. 

You might end up with estrogen dominance (the highs on the rollercoaster) which can keep thyroid hormone from attaching or making their way into the receptors on your cells. This means your cells are not getting thyroid hormone creating hypothyroid symptoms. 

Thyroid hormones are similar in chemical make up to estrogen. Too much estrogen or eating too much soy can block the receptor sites as well leaving you with less thyroid hormone in your cells and hypothyroid symptoms. 

As we lose our progesterone, we may see or feel a need for more thyroid hormone. We need progesterone to get T3 which is what our cells use and need. 

Our thyroid naturally slows down as we get older and therefore will not be able to get enough hormone to our cells affecting not only our energy but creating all the other symptoms we have talked about before. 

If you are dealing with chronic stress, and most of us are, this will also affect our ability to make enough thyroid hormone. 

When your thyroid is not working optimally or you are not medicated optimally, all of your hormones will be disrupted. 

It will be important to know if you are in menopause or if you’re having a thyroid problem. If you take estrogen thinking you are in perimenopause or menopause and it is actually your thyroid causing the problems, you might end up feeling worse and the estrogen will affect your thyroid function. Vicious cycle as with so many things in our body. One can’t work well without the other. 

If you have crazy periods during your 30’s and 40’s it is more likely an issue with thyroid than perimenopause. Thyroid problems are often the cause of early perimenopause. I’m a textbook example of this. 

They make the symptoms of perimenopause and menopause worse, affect blood sugar, make you depressed, affect your ability to handle stress. 

You have options: 

• start with journaling your food to pinpoint

  • are you eating enough

  • are you eating too much sugar

  • is your ratio of protein fats and carbohydrates where it should be

  • are you eating a lot of processed foods or a whole foods diet?

• exercise

  • reduces hot flashes

  • better mood

  • lessens depression, less anxiety

  • higher sex drive

  • sleep is better

  • more energy

  • lowers insulin resistance

  • increases bone density

  • helps manage weight

• natural supplements- introduce 1 at a time and wait 2-3 weeks before adding another one

  • maca powder

    • will help your hormones adapt and balance as needed

    • can reduce hot flashes

    • supports the entire endocrine system, including adrenals and thyroid

    • can regulate menstrual cycles

    • can increase energy and stamina

    • don’t take it if you are on estrogen

  • soy- is supposed to be helpful as a phytoestrogen to help with menopausal symptoms. I’m not sure how I feel about this. Don’t supplement but get it in food form. I would go for tempeh and miso and NOT genetically modified. 

  • Black cohosh

    • helps to reduce hot flashes

    • helps insomnia, fatigue, anxiety, depression

    • helps with joint pain/body aches

  • Damiana- tea or tincture (2-3 ml 2 to 3x/day)

    • helpful for hot flashes, low sex drive and general well being

  • Dong Quai

    • hot flashes, insomnia, fatigue, anxiety

  • Vitamin D

    • helps regulate endocrine system

    • supports sleep

  • Chasteberry or Vitex

    • helpful for breast tenderness

    • balances progesterone

    • water retention

    • headaches, irritability, depression, fatigue

    • sleep issues

The Period Repair manual is a must read for every woman

Supplements suggested can be bought through this trusted source (my fullscript store)

What is autoimmunity? Leaky gut, the immune system, and gut bacteria. Episode 28.

Welcome to episode 28. I kind of feel like I left you in the dust last week by cutting things off at intestinal permeability. I’m still working on getting my TSH in normal range and my brain had had enough. It felt like too much work to dive deeper and so I ask you to have patience with me as my brain and body get back up to speed with all that I want to share with you. I had some kind of bug last week where my body ached which didn’t help me feel like doing much but lounging around. I did some research for a client and that was about it. I am fighting fatigue for a number of reasons, and am honoring my body’s need for rest. 

I want to say something about medication. It is not a bad thing to have to take thyroid hormones. Sometimes the damage done to the thyroid is so great that the gland just can’t make enough hormone for your cells. Some of us will need lifelong hormone replacement even after all the diet and lifestyle changes we have made and that is okay. It doesn’t mean you are a failure. It’s okay to need medication. All the diet and lifestyle stuff will help. It might even help you need less medication- just don’t feel bad if you still need to take it. 

Ok so lets dive more in to Hashimoto’s and the things that can affect it. You know you need to heal your gut if you listened last week. How do you do that? You have to lower inflammation. This starts with changing your diet and your lifestyle. An elimination diet or autoimmune protocol diet - AIP- can be very helpful. I’ll cover that more in detail in another podcast. 

Before I talk about the gut let’s talk a little bit about the immune system. When you have an autoimmune disease such as Hashimoto’s, your immune system is attacking self. It is attacking proteins in your body that are part of you. Our immune system is supposed to protect us from invaders like bacteria and viruses. In autoimmune disease it is attacking our tissues, like the thyroid. This means that autoantibodies have been created. Antibodies against our own tissue. 

Antibodies are important parts of our immune system where they recognize proteins in things like bacteria, viruses or parasites. The autoantibodies or antibodies hang on to the invader and signal the immune cells to launch an attack. In autoimmune disease, your body mistakenly makes antibodies to our own tissue as well as to the things that don’t belong like the virus or some bacteria.  

When your body creates antibodies against proteins in your own tissue this is called molecular mimicry or being cross reactive. This is the beginning of how you develop an autoimmune disease. 

Your genes will predict the probability of your immune system creating the autoantibodies and it will be your environment (diet and lifestyle) that cause the immune system to actually create them. How many genes you have that say you have susceptibility to autoimmunity will determine how quickly your autoimmune disease is triggered by your environment and how severe it will be. 

Your autoimmune disease likely happened or manifested because the autoantibodies formed and your body wasn’t able to determine the difference between the antibodies formed against your own tissue and the antibodies that formed against foreign invaders. Then your immune system launches the attack against both the foreign invader and your own tissues which eventually causes enough damage to your own tissue that will result in you having symptoms of disease. In the case of Hashimoto’s the symptoms result in what would look like hypothyroidism or a slow thyroid or it could trigger Graves disease which is a hyperthyroid state. 

You don’t have any control over your genes but you have a lot of control over your diet and lifestyle or what would be referred to as your environment. In order for you to understand why your body has essentially began an attack on you it might be a good idea to understand how your immune system works. 

We are all made up of various types of proteins. They are what are called the building blocks of the body. The bricks your house is made of so to speak. Proteins are broken down in to amino acids which form all kinds of things in the body. Some amino acids are essential, building everything we are made from. When some of these amino acids get strung together, they create proteins.  Our DNA is made from proteins and so is pretty much everything else in our body.

Antibodies created by our immune system are also a protein and they are called immunoglobulins. You may have been tested for IgA, IgE or IgG antibodies. What these immunoglobulins do is look for certain amino acids that are strung together a certain way in some proteins. They then attach themselves to these amino acids strung together and keep the protein from working properly. Once it binds to this protein and basically deactivates it, it lets the immune system know that this protein does not belong and should be attacked. 

Your immune system will then attack the whole thing, not just that little protein that was recognized. So if it is bacteria, the whole bacteria gets attacked. The same thing happens to our thyroid when there is a case of mistaken identity. The thyroid tissue gets attacked and the immune system remembers that the proteins in our thyroid are something that need to be attacked just like it would remember to attack the same bacteria if it invaded our system. So when you have an inflammation in your body, your immune system may be on constant high alert and attacking thyroid tissue because its protein structure is similar to something else being attacked. One common issue is foods that have similar protein structure like the protein in wheat or gluten- called gliadin. 

There is so much more to this- this is a vey simplified version of what is going on in our body. 70-80% or so of our immune system lies in our gut and the lining in our gut being in tact is crucial in the prevention of autoimmune disease. 

The small intestine also is where about 90% of absorption of nutrients happens through the microvilli. The microvilli are little fingerlike projections that line the small intestine also called the brush border. The microvilli  take up the nutrients from the food we eat and helps to transport those nutrients into the blood stream.  This is how your cells get the nutrients they need to work well. 

The adult small intestine is about 16 feet with a diameter of about 1 inch but the microvilli increase the surface area to be 500 times greater than that.

There is a mucosal layer- and that is just what it sounds like. A layer of mucous that lines the cell wall of the intestines keeping the outside contained to this area. What that means is, like I stated last week, our digestive tract is exposed to the outside and it protects the rest of our body (the inside) from harm. 

The wall of the intestines can become damaged in a number of ways- toxins, bacteria or pathogens and even from proteins found in grains, beans and even nightshades like tomatoes and potatoes. They can actually cause microscopic holes to be formed in the small intestines which allows undigested food particles, proteins and toxins to leak in to the blood stream causing inflammation and immune system reactions. 

The tight junctions formed in the wall of the intestine are one of the lines of defense that keep the inside protected from the outside. They are supposed to open up to our insides for certain nutrients to get absorbed properly.  Zonulin is a protein in our gut that acts like a gate keeper and will monitor the opening and closing of the tight junctions. 

One study describes the workings of zonulin quite well. The study done by Alessio Fasano in 2012 found that zonulin played a role in increased intestinal permeability (leaky gut) which “may be influenced by the composition of the gut microbiota” which contributes to autoimmune disease when antigens are present. Zonulin is a protein in our intestines that regulates the tight junctions in the small intestine which means it basically controls when or if there will be openings created/permeability in the small intestines where things from the outside can have access to our insides. 

The biggest triggers for zonulin to cause the small intestine to loosen the tight junctions (again, giving access to our insides) are exposure to bacteria and gluten. The bacteria discussed in the study were infections that trigger an immune response.  The protein gliadin which is in wheat was the other big trigger for zonulin to cause the tight junctions to open or create intestinal permeability/leaky gut. 

This may be partially why a gluten free diet is so helpful for people with autoimmune disease. There is some thought that all of us with autoimmune disease may have a gluten sensitivity.  Once the immune system recognizes a protein in a food, it can recognize similar proteins in other foods which can lead to multiple food intolerances. Gluten and proteins in dairy, oats, yeasts used in baking and in brewing as well as in many other grains are all similar enough that there can be a likelihood that you may be sensitive to one or more of these foods in addition to gluten. 

It doesn’t mean that you are but that there could be a likelihood of developing additional sensitivities to those foods. 

Hopefully I have established that the health and or integrity of the small intestine is important for your health when dealing with autoimmune disease. Diets like the autoimmune protocol are very helpful in determining which foods are giving you trouble and are cheaper than food sensitivity testing which isn’t always the most reliable.

Other things that can affect intestinal permeability are things like NSAIDS- ibuprofen or acetaminophen, hot peppers like cayenne, alcohol, the wrong types of bacteria in your gut, stress, exercising too hard, surgeries and food allergies. 

If it is not clear to you yet, you need to fix your gut in order to calm your immune system. It starts with digestion. You need to have good digestion, you need to have regular bowel movements that are about a 3 or 4 on the bristol stool chart. Your eliminations should be daily, 1-2 times a day. Your stool should be about the length of your forearm from your wrist to your elbow. It should come out with ease, and there should be little to nothing on the toilet paper when you are done. 

Eliminations should be about 16-24 hours after you eat- that means that what you ate should come out of you about 16-24 hours later. You also want to have a good balance of bacteria in your gut. You can feed the “good” guys by consuming lots of vegetables and fermented foods. 

We have more bacteria living in our digestive tract that we are made of cells. There are trillions of them and there are hundreds of different species of bacteria that make up those trillions. Usually though, you have a portion of bacteria that dominate your gut- these guys kind of run the show.

They help us digest sugars, starches and fiber in our food so we can absorb the nutrients from them. These bacteria provide us with certain chemicals that help us with energy production and help regulate our metabolism. They also make B vitamins and vitamin K and increase our ability to absorb our fat soluble vitamins A, D, E and K. 

A good or healthy gut bacteria help our immune system operate properly or keep it operating as it should. When we experience what is called gut dysbiosis or having the bacteria out of balance, we start to see dis-ease or symptoms of digestive upset. 

Feeding the bacteria the proper foods helps keep in balance the good and bad bacteria  which keeps your immune system operating properly. What you put in your mouth directly affects the amount and type of bacteria living in your gut. This is why diet changes are so important when you are looking to heal your gut or bring your body back in to balance. 

I will cover the diet changes needed in a future episode so please stay tuned for that. Do you have any questions about this episode? Go to helpforhashimotos.com and look up Episode 29 on the blog. You can read the transcript there and you can leave a comment or question under the blog post. 

Be sure to sign up for my newsletter there and get your free ebook 5 Things Your Doctor Won’t Tell You About Hypothyroidism. 

Join me on facebook in the Help For Hashimoto’s facebook group and on Instagram at @StephanieEwalsNTP. 

If you like what you are hearing I would appreciate it if you left a review on iTunes so more people can find the show and be helped. 

Look for information coming soon about a live group coaching program for those of you who don’t even know where to begin with the diet and lifestyle changes. The program will be live video calls and I will walk you through how to make the changes you need in order to feel your best. You will get nutrition and thyroid education as well as support from the group. Please let me know if this is something you would be interested in. 

Thanks so much for listening. See you next week. 

Looking for a way to exercise with chronic illness? Check out Autoimmune Strong.