For Women Only
In This Chapter
- PMS symptoms interacting with hypothyroidism
- Thyroid-related causes of infertility
- Preventing a thyroid-related miscarriage
- Managing thyroid ills during perimenopause
If you’re a woman, you’re over five times as likely to develop thyroid disease as a man. Your chances of being struck by a thyroid disorder at some point in your life may be as high as 20 percent.
You also have special challenges that men don’t. For example, going through hormonal upheavals such as PMS and menopause isn’t fun even under normal circumstances; but having thyroid disease will make such tough times substantially worse. And if you’re having trouble getting pregnant, you should be aware that hypothyroidism might be preventing it from happening.
This chapter covers the special impact thyroid disease has on women. In most cases, treatment is quick and easy—as long as you’re empowered with the knowledge of how to recognize a thyroid-related problem and manage it.
PMS
If you have premenstrual syndrome, you’re far from alone. PMS has been estimated to affect over 85 percent of women between the ages of 20 and 40. While PMS symptoms are no picnic even when you’re healthy, they can magnify when combined with thyroid issues.
To appreciate why, you first need to understand what’s happening in your body during your monthly cycle. After you comprehend the causes of PMS and how they interact with thyroid symptoms, you may find that thyroid medication coupled with simple over-the-counter remedies help enormously.
Throat Quote
Just before their periods, women behave the way men do all the time.
—Robert Heinlein
Understanding PMS
If you’re typical, your period lasts 3-5 days. If we count the first day of bleeding as day 1, then ovulation occurs on days 10-15; and your whole cycle lasts 28-30 days.
Your ovaries produce two primary hormones, estrogen and progesterone. They’ll begin secreting estrogen a day or two before ovulation. After that your estrogen level will go down for a while, and then reach its highest levels during days 17-23. Progesterone isn’t made during the first half of the cycle, but is secreted right after ovulation, and then maintained at high levels during days 16-25. That means both estrogen and progesterone are operating in force during days 17-23, with their peak around day 21.
These hormones travel through your entire body, first targeting your brain, your breasts, and your uterus. They then recirculate and go to your liver, where they get bound up by carrier proteins (mostly glucuronic acid) and are then sent through the bile into your colon. If all goes well, these hormones then leave your body via the stool.
But what often happens during peak hormone production—around day 21—is a certain amount of hormones escape the liver, or become loosened from their carrier proteins in the colon, and reenter your bloodstream. They’ll then circulate around your body again. As they do, by-products from these “used” hormones have negative effects on your brain’s chemistry. For example, they can make you feel depressed, anxious, angry, or edgy; make you foggy and forgetful; and lead to mood swings and crying spells. They can also make you crave sugar and/or salt.
The by-products can additionally affect your breasts, making them enlarged and tender. And they can thicken the uterine lining, making it harder to push out through the cervix, which leads to menstrual pain and cramps. These hormones with bad by-products will then return to your liver and colon; but they might escape and recirculate one or two more times before finally exiting your body. The problems they cause are a large reason why you feel uncomfortable a week or so before your period.
Another factor is that the hormones moving through the colon change the colon’s chemistry. This can cause nausea, upset stomach, gas, bloating, irregularity, constipation, and/or diarrhea. The high level of hormones can also raise the background level of inflammation in the body, leading to backaches, headaches, and joint and muscle pain.
On top of all that, estrogen blocks T3 from entering your cells’ membranes. This means when you have more estrogen in your system, fewer cells in your body can make use of available thyroid hormones.
If your thyroid is working normally, you’ll simply ride out the third week in your cycle when estrogen is peaking and keeping you from receiving the full benefit of available T3. But if you’re already on the verge of hypothyroidism—if your thyroid is subtly underperforming, or if you’re on thyroid medication but the dosage is too low—then hypothyroid symptoms are likely to become prominent. These include fatigue, insomnia, acne, weight gain, and more (see Chapter 6). They also include symptoms you might already be accustomed to as a result of recycled hormones affecting your brain chemistry, such as depression, anxiety, and mood swings. However, the lack of adequate T3 can make what might otherwise be mild problems into major ones.
These ills can be difficult to recognize as thyroid related because they’re common aspects of PMS. But if you’re experiencing an abrupt increase in their severity, or notice symptoms that have never happened before, then don’t hesitate to get your thyroid tested.
Thyroidian Tip
When you get your blood taken for thyroid testing, be sure to tell your doctor where you’re at in your cycle. That’s because if you’re in week three (when your hormones are peaking), your TSH level will be artificially raised a bit, making it appear higher than it really is the rest of the month. An experienced doctor will know this and take it into account when evaluating your test results.
If testing reveals you’re hypothyroid, then the most effective way you can reduce your PMS symptoms is by starting on thyroid medication. In addition, there are some simple things you can do to help your body prevent “used” estrogen hormones escaping from your liver or colon to re-circulate and spread unhealthy byproducts.
First, cut down on coffee, because caffeine helps estrogen escape the liver. It’s also helpful to reduce methylxanthines, which are caffeine-like substances contained in chocolate and cocoa products.
Next, during the third week of your cycle when estrogen is peaking, consider taking 500 milligrams a day of calcium d-glucarate. This is an over-the-counter version of glucuronic acid, which is the protein your body uses to bind estrogen and keep it from leaving your colon. Calcium d-glucarate has virtually no side effects; and increasing your body’s supply of glucuronic acid when it needs it most will help ensure the used estrogen stays in your colon until your body is ready to evict it via the stool.
Crash Glanding
When you look for calcium d-glucarate, don’t mistakenly buy calcium glucanate. While their names are very similar, they’re entirely different chemically and have entirely different effects.
You should also get more fiber in your colon. Fiber creates helpful bacteria that degrade used hormones into harmless chemicals (and, as a nice side effect, lower long-term risks of breast and ovarian cancer). Ideal for this purpose is ground flax seed, which you can find in any health food store. Sprinkling a couple of tablespoons a day on top of cereal, smoothies, or soup during the third week of your cycle should do the trick. It’s best to spread out the two tablespoons over a few meals instead of consuming it all at once, though; otherwise you may feel gassy and bloated until your body gets used to the ground flax seed.
In addition, take calcium during your third week—specifically, 1,300-1,500 milligrams per day of calcium citrate or calcium citrate malate. These calcium supplements help to inhibit hormone byproducts from acting on your brain cells.
If you’re experiencing significant aches, pains, and cramping, over-the-counter anti-inflammatories such as ibuprofen and naproxen sodium are fine for most people, as long as they’re used short-term and at the recommended doses.
More generally, living healthy makes a big difference (see Part 5). Choose a balanced and nutritious diet, exercise regularly, get enough sleep, and engage in relaxing activities like spending time with friends. The stronger your body and mind are, the less vulnerable you’ll be to hormonal byproducts.
Further, maintain a steady level of blood sugar. For example, don’t skip meals, and eat balanced portions at each meal. Otherwise your adrenal glands may produce extra cortisol (see Chapter 14), and that can add to the hormonal havoc of PMS.
If all these relatively simple measures aren’t enough, though, you can additionally turn to your doctor for help.
For example, most PMS problems are caused by high levels of estrogen, while progesterone serves to block estrogen. If you’re between 35 and 45, there’s a chance your ovaries are secreting less progesterone, which means your body is effectively dealing with more estrogen, heightening your PMS. It’s a bad idea to self-medicate progesterone because it’s not always needed, and it has significant side effects; but you can ask a doctor who’s an expert on PMS to check your hormone levels when you’re around day 21 of your cycle and, if appropriate, prescribe a relevant dosage of progesterone for you.
Finally, if your PMS makes you depressed and taking T3 doesn’t entirely resolve it, you can ask your doctor to additionally prescribe an antidepressant. For example, there’s a PMS-specific version of Prozac designed to be used only during the third week of each cycle.
If a thyroid problem is underlying your PMS issues, there’s a good chance taking thyroid medication and following at least some of the solutions just described will allow you to live relatively happily with your PMS.
Infertility
One of life’s most precious gifts is our ability to have children. And so one of the most heartbreaking ailments is the seeming inability to become pregnant. Fertility problems sometimes stem from genetics or from age. But they’re also often brought about by thyroid disease, which is easily treatable.
Hypothyroidism can cause infertility in a number of ways. First, thyroid hormones—and particularly T3—regulate the rate of cell growth. If your body doesn’t have enough T3, it can inhibit the formation of the cells that support the egg, or ovum. A telltale sign of this occurring is irregular cycles.
Low T3 can also inhibit the production of progesterone, a hormone critical for ovulation. If this happens, your periods may stop altogether.
Another reason for infertility is a hormone called prolactin, which your body normally produces after you give birth to make your breasts lactate. Prolactin inhibits a sperm’s ability to enter an egg, making it unlikely (though not impossible) that you’ll get pregnant while nursing your newborn baby.
When your thyroid is underactive, your pituitary gland will release more TSH to stimulate the production of thyroid hormones. By coincidence, the pituitary is also in charge of making prolactin, and sometimes when it’s churning out an unusually large amount of TSH, it’ll inappropriately churn out prolactin, too.
In fact, having a high level of prolactin is one of the first noticeable signs of early thyroid disease. There usually won’t be enough prolactin to make you lactate, but it could cause your periods to abruptly stop. And even if the latter doesn’t occur, the prolactin will vastly decrease your chances of getting pregnant. Once you treat your hypothyroidism, though, your pituitary gland will stop making excessive TSH—and will simultaneously quit secreting prolactin.
Miscarriage
As painful as infertility is, even more tragic is a miscarriage. Unfortunately, thyroid problems greatly increase this risk, especially during the first trimester.
That’s because for the first nine weeks your baby can’t make thyroid hormones, and so must rely entirely on your own T4 and T3. If your thyroid underproduces its hormones during this time and you don’t take medication to correct the imbalance, it can severely impair your baby’s development.
Further, if your hypothyroidism is caused by an autoimmune response, the increase in roving antibodies seeking foreign invaders to attack poses an additional danger to your baby.
It’s common to be mildly hypothyroid before becoming pregnant and not be aware of it. It’s also common to be latently hypothyroid—that is, have no symptoms at all, but be on the verge of thyroid disease. In either case, the upheaval of hormones that comes with pregnancy can nudge a thyroid from being barely healthy to ailing.
Pregnancy also brings vast changes to your immune system (because your body suddenly has to take into account not only your health but the health of your baby). As these transformations occur, they can spawn antibodies that attack both your thyroid and the thyroid hormones circulating in your blood, putting you into a hypothyroid state.
To make matters worse, hypothyroidism is far from obvious during pregnancy, because many of its symptoms—such as weight gain, fatigue, mood swings, and insomnia—can be attributed to the pregnancy itself.
Therefore, if you’re pregnant, it’s important for your doctor to test your thyroid (including antibody testing) as soon as your condition is known, and at least every 2-3 months after that.
If your thyroid is healthy, no harm is done in checking it. But if it’s started underperforming, then thyroid medication will quickly get your T3 level back to where it needs to be; and it’ll also lower your TSH level, which is likely to reduce antibody activity. This helps ensure your pregnancy remains on course.
Alternatively, you could become hyperthyroid during pregnancy. This is much less common; it happens only about 1 percent of the time. The main dangers are an increased heart rate for both you and your baby; a quicker metabolism, which can impair your body’s ability to deliver sufficient nourishment to the baby; and a surplus of thyroid hormones, which will do you no harm but poses a risk for your still-developing child. Since neither radiation nor anti-thyroid medications are safe for your baby, the best option for this situation is generally surgery to reduce your thyroid’s size. If the result is an underactive thyroid, you can then take medication to get your thyroid hormone levels back to normal.
Postpartum Problems
Virtually everyone knows that a woman’s body goes through massive hormonal and immune system changes during pregnancy. What not so many people consider is that it goes through similar transformations after giving birth. The conditions the body operated under for nine months no longer apply, and so it has to make major adjustments.
For example, there are very high levels of the hormone progesterone during pregnancy, which helps thyroid hormones enter cells efficiently and so lowers the amount of work the thyroid has to do. After birth, however, there’s an enormous drop in progesterone levels. This puts an abrupt and heavy strain on the thyroid, which all of a sudden needs to produce substantially more hormones than it was accustomed to for the previous nine months. This shock can trigger either a temporary or permanent thyroid problem.
One result is an autoimmune disorder called Graves’ disease (see Chapter 10). The good news is there are more options for managing hyperthyroidism after pregnancy than during it (see Chapter 12).
A disease that so frequently occurs after birth that it takes its name from it is postpartum thyroiditis (see Chapter 15). Because this is an autoimmune disease, antibody testing is especially important to detect it. This illness tends to end automatically after several months, and in the meantime is quite treatable; the trick is diagnosing it before a great deal of unnecessary suffering takes place.
Most common of all is hypothyroidism. This can cause unrelenting postpartum depression, as well as other severe symptoms. As terrible as its effects can be, however, it’s the most easily treatable of these thyroid conditions (see Chapters 8 and 9).
During the first six months after you give birth, you’ll be faced with numerous challenges: learning to be a good parent, dealing with lack of sleep, and becoming a magician at juggling multiple tasks. It’s normal to feel physically run down and emotionally exhausted from it all. But if you’re suffering from thyroid disease on top of that, you’ll feel much worse than any mother should have to. If you suspect your thyroid is malfunctioning, don’t hesitate to see your doctor. A simple blood test and some inexpensive pills may spare you from awful symptoms during what should be the happiest time of your life.
Perimenopause and Menopause
Unlike thyroid disease, diagnosing menopause couldn’t be more straightforward. There are no lab tests involved, and only one relevant symptom: whether you’ve had any periods over the past 12 months.
If you have, but your periods have been increasingly intermittent over time, then you’re in perimenopause. This is a long-term stage during which your sex hormones—first androgen (which influences your sex drive and energy level), then progesterone, and finally estrogen—are steadily declining.
Specifically, around ages 38-42 your androgen levels significantly lower. This typically dampens your libido, slows your metabolic rate, and causes a general feeling of fatigue. It can also diminish the growth of lean body mass, forcing you to exercise more to avoid gaining fat (even as it makes you feel less energetic about exercising).
Throat Quote
There is no better time for women approaching or currently going through menopause to start or renew an exercise program. Physical activity can play an important role in counteracting many of the changes a woman experiences … including the increased risk of weight gain, heart disease, and bone loss. In addition to exercise, a low-fat, high-fiber diet rich in calcium can also help ward off symptoms.
—Fitness expert Sabrena Newton
Around ages 42-45 progesterone levels decrease, which usually makes your PMS symptoms more severe and alters the timing of your cycles (causing you to miss periods, or at the other extreme experience mid-cycle bleeding).
Around ages 45-47 estrogen levels go down. The lessening stimulus of the uterine lining to thicken itself and cause your cycle to occur eventually leads to your periods stopping. It’s during this phase that you start experiencing night sweats and hot flashes.
Your last menstrual cycle typically occurs within a few months of your fiftieth birthday (though if it happens a few years earlier or later, that’s perfectly normal, too). And a year after that, you’re officially in menopause.
All these phases involve major changes to your body’s hormone activity, and that opens the door to your thyroid becoming strained and defective. When you consider the odds of getting thyroid disease go up with age anyway, it’s understandable that many women become hypothyroid at some point during perimenopause.
Unfortunately, the hypothyroidism is often missed by doctors, because its key symptoms—weight gain, fatigue, and depression—can be attributed to perimenopause-related changes. That means it’s your job to keep a special eye out for thyroid symptoms during this time of your life. If you have any reason to suspect hypothyroidism, see your doctor and get tested.
And even if you don’t notice any symptoms, it’s a good idea to get tested as part of your annual checkup once you begin perimenopause. Having a baseline reading on your thyroid hormone levels will make it easier for you and your doctor to later notice subtle indications that your thyroid is starting to underperform. If your T4 and T3 levels remain normal but your TSH begins creeping up, try following the advice in Chapters 18 and 22; it may help you avoid progressing into hypothyroidism.
- If your PMS symptoms are severe, get your thyroid tested to learn whether it’s making a tough time worse.
- If you’re experiencing trouble getting pregnant, have your doctor check your thyroid.
- Get tested for thyroid disease as soon as you learn you’re pregnant, and then every 2-3 months during the pregnancy.
- Get tested for thyroid disease—including antibody testing—within a few months of giving birth.
- Get tested for thyroid disease as part of your annual checkup from around age 38 on.