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Erratic periods? Hot flashes? Night sweats? Mood changes? Vaginal dryness? Sleep problems? Exhaustion? Welcome to perimenopause! During this transitional period, your hormone levels fluctuate – often for years – until your final menstrual period. Perimenopause can be miserable, and hypothyroidism often makes the symptoms even more difficult!

Yes, perimenopause is an unavoidable fact of life. But suffering through perimenopause is not inevitable! Ahead, a look at what a woman with hypothyroidism can do today to make this transition easier.

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The term perimenopause means “around menopause.” Technically, perimenopause begins when your reproductive hormones – primarily estrogen levels and progesterone - start to fluctuate and drop. This decline typically begins sometime between your late 30s into your late 40s. One year after your last menstrual period, you’re considered “menopausal.” In the U.S., the average age of menopause is around 51. The median length of perimenopause is about four years, but the perimenopausal transition lasts far longer for some women.

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The medical term for the symptoms around perimenopause is “climacteric syndrome.” These symptoms include the following:

Irregular periods: Periods are more or less frequent, menstrual flow can be heavier or lighter, and some women miss periods

Vasomotor symptoms: Vasomotor symptoms of perimenopause include hot flashes, night sweats, “body buzzing” – internal tremors or electrical shock sensations, and tingling sensations, known as paresthesias. (An interesting note: one study found that for women with Hashimoto’s and hypothyroidism, feeling especially cold – including in the hands and feet -- can also be a vasomotor symptom.)

Sleep problems: Insomnia, frequent waking, and early waking

Fatigue: Exhaustion, daytime sleepiness

Mood changes: Depression, irritability, anxiety, and rapid mood changes

Vaginal problems: Vaginal dryness, lack of lubrication, painful intercourse, increased risk of vaginal infections

Bladder Problems: Increased risk of urinary tract or bladder infections, increased risk of urinary incontinence

Sexual Function: Reduced libido, slower arousal

Bone Health Problems: Reduced bone density, brittle bones, increased risk of osteopenia and osteoporosis (and bone fractures)

Cognitive issues: Difficulty concentrating, memory problems

Gastrointestinal problems: Bloating, water retention, gassiness, digestive problems

Weight gain: Especially in the abdomen, hips, and buttocks

Other symptoms: Breast tenderness, headaches, joint and muscle pain, hair loss, and dry skin

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It’s no coincidence that perimenopause is when thyroid hormones also fluctuate and can decline, as there’s a significant relationship between thyroid and reproductive hormones.

A fascinating study published in late 2022 gives us greater insight into which women with Hashimoto’s and an underactive thyroid are at the most risk of perimenopausal symptoms. The study divided the perimenopausal women with Hashimoto’s into three groups:

• women with a TSH level from 0.4 to 2.0 mU/l (low normal)
• women with a TSH level in the range of 2.1–4.0 mU/l (average to high normal)
• women with a TSH level above 4.1 mU/l (elevated)

28% of the women had no perimenopausal symptoms, and the remaining women had symptoms of varying severity. The study identified the key risk factors for perimenopausal symptoms.

A thyroid disorder, specifically Hashimoto’s thyroiditis, was the most critical risk factor. Women with untreated or poorly controlled Hashimoto’s and hypothyroidism were at higher risk of perimenopausal symptoms.

The other significant predictors of the risk of perimenopausal symptoms were the following:

A history of chronic stress and anxiety.

A low level of physical activity. Regular physical activity helps boost mood and improve sleep quality. It also helps build bone strength. Australian researchers have even found that exercise during perimenopause significantly reduces hot flashes. One study found that regular physical activity in the form of yoga – a combination of exercise and stress reduction – substantially reduces the range of vasomotor symptoms.

Smoking is associated with premature and earlier menopause. Women who smoke tend to start perimenopause and reach menopause several years earlier than average.

Excessive use of alcohol can suppress hormone levels and worsen perimenopausal symptoms.

Other factors also play a role in the severity of perimenopause symptoms, but were not discussed in the research study. These include:

• Exposure to polybrominated diphenyl ethers (PBDEs): These flame-retardant chemicals are endocrine disruptors that can slow thyroid function and lower estrogen reserves. According to research, exposure to these toxins may worsen estrogen balance and contribute to perimenopausal symptoms.
• Magnesium deficiency: Studies have shown a significant relationship between magnesium levels and thyroid function. Declining magnesium levels – hypomagnesemia – during perimenopause and menopause can worsen thyroid function and perimenopausal symptoms. ncbi.nlm.nih.gov

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In the study of predictive factors, the researchers state that “the decay of women’s health starts many years before menopause and prevention of its consequences is an important task…” In other words, your habits and behavior in your 20s and 30s can prevent – or worsen -- symptoms of perimenopause and its complications in your 40s and 50s!

Let’s look at what you can do now to have an easier perimenopause later!

1.    Optimize your thyroid function, and manage it carefully

The more carefully managed and optimally treated your hypothyroidism, the lower the risk of debilitating perimenopausal symptoms. It’s not enough to have thyroid hormone levels in the “normal” range. Your goal should be optimal hypothyroidism treatment. Get a thyroid panel at least twice a year, and check in with your thyroid practitioner at least once yearly.

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2.    Focus on reducing thyroid antibodies and autoimmunity

Learn about the role of thyroid antibodies, and incorporate practices and treatments to help lower them. These include the Autoimmune Protocol (AIP) diet, selenium supplementation, Low Dose Naltrexone (LDN), and other approaches.

3.    Practice physiologic stress reduction

Make it a habit to incorporate at least 10 minutes a day of a physiologically stress-reducing practice into your daily routine. Remember: Stress reduction is different from relaxation or vigorous exercise. Choose an activity that lowers your heart rate, respiration rate, and cortisol levels for stress reduction benefits. Some effective activities include breathwork, meditation, prayer, gentle yoga, Tai Chi, Qi Gong, crafting, needlework, and playing a musical instrument.

4.    Get regular physical activity

You also should incorporate more physical activity into your daily life. We have many helpful articles on the Paloma blog on exercise and activity and how to get started – or ramp up your activity level. -- The studies discussed found that women who got the equivalent of 8,000 – 10,000 steps a day had the lowest risk of perimenopausal symptoms.

5.    Quit smoking

Paloma has a helpful article on how to quit smoking and develop a personalized quit plan.

6.    Avoid alcohol, or drink in moderation

If you drink to excess, it’s time to cut back. Paloma has an informative article with additional guidance. And here’s a valuable tip: The nonalcoholic beer, wine, and liquor industry is booming! You have more choices than ever for delicious drinks and cocktails with no alcohol. Get started by checking out this helpful guide to the best nonalcoholic spirits.

7.    Minimize your exposure to endocrine-disrupting chemicals

Avoid using flame-retardant fabrics, carpets, and sprays (Scotch-Guard) in your home, and also be careful about other endocrine-disrupting chemicals. Paloma’s article provides an excellent guide to chemicals that can harm your thyroid gland.

8.    Check your magnesium levels

Test your magnesium levels, and if they’re not optimal, start by reading this article on the benefits of magnesium for thyroid health. If you’re going to supplement with magnesium, this article outlines the best type of magnesium for people with hypothyroidism.

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You should regularly get complete thyroid function tests to create your plan for perimenopause and manage your thyroid treatment. One convenient way to get your thyroid tested is with the Paloma Complete Thyroid Blood Test kit. The affordable and convenient at-home thyroid test kit from Paloma comes with everything you need to test Thyroid Stimulating Hormone (TSH), Free Thyroxine (Free T4), Free Triiodothyronine (Free T3), and Thyroid Peroxidase Antibodies (TPO), with an option to add on tests for Reverse T3 (RT3) and vitamin D.

For careful diagnosis, management, and optimal thyroid treatment, consider adding a practitioner to your team with expertise in Hashimoto’s and hypothyroidism. You can get high-quality care from Paloma’s top thyroid doctors, who provide comprehensive diagnosis and optimal treatment of Hashimoto’s and hypothyroidism from the convenience of your home.