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Hormonal changes are standard in the menstrual cycle. But, if you have an autoimmune disease like Hashimoto's disease, these natural shifts in your hormone levels can affect your already overactive immune system. In turn, it can also impact your thyroid gland. Many women with PMS struggle to control their Hashimoto's symptoms in the days leading up to their menstrual period. Let's learn why this may happen and what you can do to keep your symptoms at bay.
People sometimes throw the term 'PMS' around (often inappropriately), but this condition is very real for many women. Indeed, it is a recognized medical condition, and many women find that PMS is a debilitating problem they face monthly.
PMS stands for premenstrual syndrome, and women with this condition often suffer from a slew of physical, mental, and emotional premenstrual symptoms. According to the Mayo Clinic, 3 out of 4 women experience some form of PMS leading up to their period.
Symptoms of PMS can include:
- Mood swings
- Irritability or anger
- Anxiety or tension
- Changes in appetite
- Food cravings
- Poor concentration
- Libido changes
- Joint pain and muscle pain
- Breast tenderness or slight enlargement
- Abdominal bloating
- Weight gain (from fluid retention)
- Bowel changes (either constipation or diarrhea)
Unlike other health challenges, PMS is resolved with time and is usually predictable on when it will pass. For example, most women find their PMS goes away on the first day of their period.
In severe cases, some women may have premenstrual dysphoric disorder (PMDD). This intense version of PMS is chronic and requires lifestyle changes and medications to help women manage it. We don't know why some women develop PMDD. Still, it may be linked to serotonin deficiencies in the brain from hormone shifts.
Like PMDD, we don't know why the majority of women experience PMS. However, the most apparent theory points to fluctuating hormone levels. Our bodies have estrogen receptors in every organ system, meaning that changes in estrogen levels may cause our cells to respond in different ways when hormone levels shift.
This theory is supported by the changes women undergo in perimenopause when estrogen and progesterone levels fluctuate. Perimenopause means "around menopause" are refers to the symptomatic years leading up to menopause where women experience symptoms like hot flashes, insomnia, and irritability.
There is no clinical sign that a woman has PMS, meaning there is no blood test, physical exam, or imaging study that can confirm this condition. Instead, a healthcare provider will ask you questions about your medical history and your symptoms to determine if you have PMS or not.
With that said, your doctor may do a complete physical exam (including a pelvic exam) to make sure something else is not causing your symptoms, like polycystic ovarian syndrome (PCOS).
As of now, there is no concrete data that suggests women with Hashimoto's are at greater risk for PMS. However, menstrual cycle changes can potentially affect your thyroid. Women with Hashimoto's may be more reactive to normal hormonal fluctuations.
One of the more common symptoms of any thyroid disorder is an irregular period. For example, women with hypothyroidism (often caused by Hashimoto's) tend to have longer, unpredictable, and heavier periods. We know that thyroid hormones and female sex hormones like estrogen and progesterone interact and influence one another. And, because your thyroid hormones can be off-balance in Hashimoto's, the thyroid is likely to exacerbate symptoms associated with other hormonal fluctuations.
This question is where things can get interesting for women with Hashimoto's who have periods. A Hashimoto's flare-up is where your autoimmune symptoms intensify, usually because of some stressor placed on your body. One of the risk factors for a flare-up is hormonal imbalance, which may be due to sex hormones like estrogen and progesterone or thyroid hormones.
Some data shows that your female sex hormones in the first part of your cycle are pro-inflammatory, meaning that your immune system is more active and responsive. However, in the latter half of the menstrual cycle (after ovulation till the first day of your period), sex hormone levels can decrease the activity of your immune system. This decrease in immune activity allows a potential embryo to implant in the uterus without the body detecting it as foreign and trying to fight it off.
Because of the effects on your immune system, women with Hashimoto's may be more prone to an inflammatory response during the first half of the cycle. This increase in inflammatory processes is problematic for people with autoimmune diseases because it can exacerbate symptoms, eventually leading to a flare-up. Often, flare-ups show up in the second half of your menstrual cycle after inflammation has built up in the first half of your cycle.
Managing PMS is the same whether you have Hashimoto's or not. However, women who have both conditions have to carefully manage their Hashimoto's symptoms by keeping inflammation and thyroid hormone levels in check. To do this, you will want to be sure that your thyroid hormone levels are checked regularly with a thyroid function test. You will also need to take your thyroid hormone replacement medication as prescribed and lower your risk for inflammation with activities like:
- Decreasing stress
- Maintaining a healthy weight
- Getting plenty of sleep each night
- Eating an anti-inflammatory diet
- Doing daily physical activity
When it comes to managing PMS, there are several things you can try. Doctors may recommend taking NSAIDs like aspirin or ibuprofen to reduce pain and inflammation for mild to moderate symptoms. Dietary changes that nix sugar and fat while increasing protein may help as well. If your symptoms are more severe, your doctor may recommend birth control pills, diuretics (to decrease fluid retention), antidepressants, and even medications that temporarily prevent the ovaries from making estrogen and progesterone).
You do not have to be uncomfortable or miserable several days out of the month. If you have Hashimoto's and PMS, meet with a Paloma Health thyroid doctor to explore keeping your thyroid in check to manage your symptoms.
In general, even women without a thyroid condition should speak with their doctor if they have PMS symptoms. PMS is common, but you don't have to suffer or live with it. Find out what options will best serve you so you can get back to what's important in your life.