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The Connection Between Menopause and Hypothyroidism

Understand how perimenopause, menopause, Hashimoto’s, and hypothyroidism are related.
The Connection Between Menopause and Hypothyroidism
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For women, the transitional stages of perimenopause and menopause can be a challenge – even more so when she also has Hashimoto’s thyroiditis or hypothyroidism. At the same time, from perimenopause into post-menopause, women are at greater risk of developing Hashimoto’s disease and hypothyroidism. The hormonal transitions that typically start in a woman’s 40s can significantly impact health and well-being, and understanding their relationship is crucial. Ahead, a look at perimenopause, menopause, Hashimoto’s, and hypothyroidism, and what the connections mean for your health.

Perimenopause and menopause

Perimenopause, which means “around menopause,” is the stage that precedes menopause. Perimenopause typically starts at age 47 on average. During perimenopause, the body’s production of estrogen and progesterone begins to decline, leading to symptoms such as irregular periods, hot flashes, night sweats, mood swings, and sleep problems. While perimenopause lasts for four years, on average, in some women, it can continue for as long as ten years until menstrual periods stop for good.

Once it’s been a whole year since your menstrual period, menopause is officially completed. However, the drops in estrogen and progesterone continue to cause hormonal imbalance-related symptoms for a subset of women into the period known as post-menopause.

The hormonal changes that start in perimenopause can also impact the functioning of your immune system, as well as your thyroid gland.

Hashimoto’s thyroiditis and hypothyroidism

Hashimoto’s thyroiditis is an autoimmune disease in which your immune system attacks the thyroid gland, leading to inflammation and a slowdown in the gland. When the underactive thyroid can no longer produce enough thyroid hormone, the resulting condition is called hypothyroidism. An underactive thyroid can cause symptoms such as fatigue, weight gain, depression, and hair loss. Women are more likely to develop Hashimoto’s and hypothyroidism than men, and the risk increases with age.

The risk of developing both Hashimoto’s thyroiditis and hypothyroidism increases with age and women are more likely to be affected than men. The prevalence of thyroid disease, particularly hypothyroidism, is also noticeably higher in women during the perimenopausal and postmenopausal years. Additionally, the presence of other autoimmune disorders, a family history of thyroid disease, and certain environmental factors can increase the risk of Hashimoto’s hypothyroidism.

Common symptoms

Perimenopause, menopause, Hashimoto’s thyroiditis, and hypothyroidism share a variety of symptoms, which can make it challenging to distinguish the specific cause of the symptoms. The following table shows many of the symptoms that overlap.


Because they share so many common symptoms, misdiagnosis, and delayed treatment can occur, as menopausal changes can mask the signs of thyroid dysfunction, and thyroid conditions can mask the signs of perimenopause and menopause.

Estrogen, progesterone, and your thyroid

The relationship between estrogen and progesterone levels and thyroid function is complex, and declining levels of these reproductive hormones during perimenopause can directly affect your thyroid function.

These reproductive hormones help to maintain the balance of thyroid hormones in several ways.

Increased TSH levels

One of the effects of declining estrogen on thyroid function is an increase in thyroid stimulating hormone (TSH) levels. The pituitary gland produces TSH and signals the thyroid to produce more thyroid hormones. When estrogen levels decrease, TSH levels can rise, leading to hypothyroidism.

Reduced T4-T3 conversion

Another effect of declining estrogen is a decrease in the conversion of the inactive thyroid hormone thyroxine (T4) to the active thyroid hormone triiodothyronine (T3). This can result in hypothyroidism. Additionally, decreased estrogen levels can also affect the thyroid antibodies, increasing the risk of autoimmune Hashimoto’s thyroiditis.

Decreased TBG production

When estrogen and progesterone levels decline during perimenopause, it can lead to changes in thyroid-binding globulin (TBG) levels. TBG is a protein that binds thyroid hormones in the blood, and changes in TBG levels can affect the levels of free thyroid hormones (T4 and T3) available to cells. Lower levels of estrogen and progesterone can decrease the production of TBG, which leads to an increase in free thyroid hormones (thyroxine or T4 and triiodothyronine or T3) in the bloodstream. This increase in free thyroid hormones can potentially cause periodic surges in thyroid hormones and symptoms resembling hyperthyroidism, such as palpitations, heat intolerance, and mood changes.

Furthermore, studies have shown that women with thyroid disorders may be more prone to experiencing menopausal symptoms, such as hot flashes and mood swings. Thyroid hormones play a role in regulating body temperature and mood, so that imbalances can worsen menopausal symptoms.

Estrogen, progesterone, and autoimmunity

The effects of declining estrogen and progesterone during perimenopause on autoimmune diseases can vary. But in general, changes in estrogen and progesterone levels during perimenopause may impact the onset, progression, or symptoms of autoimmune diseases like Hashimoto’s thyroiditis.

Here are some general effects that declining estrogen and progesterone levels during perimenopause can have on autoimmune diseases:

Increased inflammation

Both estrogen and progesterone have anti-inflammatory effects, and the decline in these hormones during perimenopause may lead to increased inflammation and immune activation. This could potentially worsen symptoms and trigger increased disease activity in some autoimmune conditions.

Changes in symptom presentation

Fluctuations in estrogen and progesterone levels can affect the presentation of symptoms in autoimmune diseases. Some individuals may experience worsening symptoms during perimenopause, while others may notice improvements or changes in symptom patterns.

Risk of new onset or flare-ups

Estrogen may play a role in the development of autoimmune diseases, and its decline during perimenopause could potentially influence the risk of developing new autoimmune conditions or trigger the onset of symptoms in susceptible individuals. In some cases, the decline in progesterone levels during perimenopause may also trigger flare-ups or worsening of symptoms in individuals with autoimmune diseases. This could be due to increased immune activity or changes in the expression of autoimmune-related genes.

Effect on immune regulation

Estrogen and progesterone are involved in regulating the balance of immune responses, including the balance between pro-inflammatory and anti-inflammatory responses. Changes in these hormone levels may disrupt this balance, potentially affecting immune regulation in individuals with autoimmune diseases.

Impact on treatment response

Hormonal changes during perimenopause may affect the response to treatments for autoimmune diseases. Medications that target hormonal pathways or interact with estrogen receptors may need to be adjusted based on changes in hormone levels.

Studies have demonstrated that estrogen receptors play a role in preventing autoimmunity. Therefore, declining estrogen levels during perimenopause could theoretically lead to increased activity of the autoimmune response against the thyroid gland, exacerbating symptoms and potentially accelerating the progression of the disease.

It’s important to note that the interaction between estrogen, progesterone, and autoimmunity is complex and not fully understood. Individual responses can vary based on genetics, environmental triggers, and the specific autoimmune condition. Managing autoimmune diseases during perimenopause often requires close collaboration between patients and healthcare providers to monitor symptoms, adjust treatments as needed, and address any hormonal or other contributing factors.

Navigating the hormonal changes

With the right healthcare team, women can navigate perimenopause, menopause, and thyroid dysfunction while maintaining the best possible quality of life. Some of the approaches to consider include:


For some women, hormone replacement therapy (HRT) can help alleviate perimenopausal and menopausal symptoms and potentially modulate immune function, thereby influencing autoimmune activity. The decision to use HRT should be made on an individual basis, carefully considering potential risks and benefits.

In cases of overt hypothyroidism, thyroid hormone replacement medication is often necessary to normalize thyroid hormone levels. In addition, regular monitoring of thyroid function – via testing of key biomarkers – is crucial to ensure adequate dosing, especially during the hormonal shifts of perimenopause and menopause.

Lifestyle modifications

A healthy lifestyle can be pivotal in managing symptoms and improving quality of life. This includes a balanced diet rich in anti-inflammatory foods, regular physical activity, stress reduction and management techniques, and adequate sleep. Additionally, avoiding environmental triggers that disrupt hormonal balance and immune function, such as endocrine-disrupting chemicals, is advisable.

Autoimmune protocol (AIP) diet

Some women find symptom relief by following the AIP diet, which aims to reduce inflammation and autoimmune responses by eliminating potential food triggers. There is scientific evidence that shows that the AIP diet can benefit some women dealing with Hashimoto’s thyroiditis.


Certain supplements such as iron, magnesium, selenium, zinc, vitamin D, Vitamin B complex, vitamin B1, vitamin B-12, probiotics, l-tyrosine, and omega-3 fatty acids can support thyroid and hormonal balance and immune health.

Going forward

If you are a woman experiencing symptoms of thyroid dysfunction during perimenopause or treatments like HRT do not resolve your symptoms, it’s time to consult with a healthcare provider for proper thyroid evaluation. Thyroid function testing should measure TSH, T4, T3, and thyroid peroxidase (TPO) antibodies to help diagnose any underlying thyroid disorders and guide treatment decisions.

If you are a thyroid patient experiencing new or unresolved symptoms and you’re in your late 30s or older, keep in mind that your symptoms may be related to perimenopausal changes. This is an excellent time to have your estrogen and progesterone evaluated, along with an assessment of symptoms, to determine if perimenopause has started. Your healthcare provider can then provide recommendations to help resolve symptoms and balance your hormones.

It’s important to note that the relationship between perimenopause/menopause, Hashimoto’s thyroiditis, and hypothyroidism is complex and not fully understood. Individual responses can vary, and other factors such as genetic predisposition, environmental triggers, and other hormonal changes can also influence your health during this period of flux. Managing these conditions requires close collaboration with your healthcare provider to monitor your symptoms, adjust treatments as needed, and address any hormonal or other contributing factors.

A note from Paloma

The journey through perimenopause and menopause presents a unique set of challenges for women, one that Hashimoto’s thyroiditis and hypothyroidism can complicate. Understanding the intricate relationship between these conditions is the first step in navigating this complex terrain. Regular follow-ups, periodic testing, personalized treatment plans, and a supportive patient-provider relationship are key components in managing the interplay between these conditions.

If you are experiencing symptoms of – or have been diagnosed with – perimenopause, menopause, Hashimoto’s disease, or hypothyroidism, consider becoming a Paloma Health member. You’ll have access to convenient home hormone testing, nutritional and health coaching, and seasoned doctors and providers. Your healthcare team will ensure that you get proper diagnosis and treatment, as well as a holistic plan for overall health and well-being.

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Mary Shomon

Patient Advocate

Mary Shomon is an internationally-recognized writer, award-winning patient advocate, health coach, and activist, and the New York Times bestselling author of 15 books on health and wellness, including the Thyroid Diet Revolution and Living Well With Hypothyroidism. On social media, Mary empowers and informs a community of more than a quarter million patients who have thyroid and hormonal health challenges.

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