As women reach their 40s with increased job stressors,
family pressure and grief from the loss of life in their life.
A Lot changes about their body’s
What are the signs of perimenopause? You’re in your 40s, you wake up in a sweat at night, and your periods are erratic and often accompanied by heavy bleeding: Chances are, you’re going through perimenopause. Many women experience an array of symptoms as their hormones shift during the months or years leading up to menopause — that is, the natural end of menstruation. Menopause is a point in time, but perimenopause (peri, Greek for “around” or “near” + menopause) is an extended transitional state. It’s also sometimes referred to as the menopausal transition, although technically, the transition ends 12 months earlier than perimenopause (see “Stages of reproductive aging” below).
What is perimenopause?
Perimenopause has been variously defined, but experts generally agree that it begins with irregular menstrual cycles — courtesy of declining ovarian function — and ends a year after the last menstrual period.
Perimenopause varies greatly from one woman to the next. The average duration is three to four years, although it can last just a few months or extend as long as a decade. Some women feel buffeted by hot flashes and wiped out by heavy periods; many have no bothersome symptoms. Periods may end more or less abruptly for some, while others may menstruate erratically for years. Fortunately, as knowledge about reproductive aging has grown, so have the options for treating some of its more distressing features.
Perimenopause and estrogen
The physical changes of perimenopause are rooted in hormonal alterations, particularly variations in the level of circulating estrogen.
During our peak reproductive years, the amount of estrogen in circulation rises and falls fairly predictably throughout the menstrual cycle. Estrogen levels are largely controlled by two hormones, follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH stimulates the follicles — the fluid-filled sacs in the ovaries that contain the eggs — to produce estrogen. When estrogen reaches a certain level, the brain signals the pituitary to turn off the FSH and produce a surge of LH. This in turn stimulates the ovary to release the egg from its follicle (ovulation). The leftover follicle produces progesterone, in addition to estrogen, in preparation for pregnancy. As these hormone levels rise, the levels of FSH and LH drop. If pregnancy doesn’t occur, progesterone falls, menstruation takes place, and the cycle begins again.
Hot flashes during perimenopause
Most women don’t expect to have hot flashes until menopause, so it can be a big surprise when they show up earlier, during perimenopause. Hot flashes — sometimes called hot flushes and given the scientific name of vasomotor symptoms — are the most commonly reported symptom of perimenopause. They’re also a regular feature of sudden menopause due to surgery or treatment with certain medications, such as chemotherapy drugs.
Hot flashes tend to come on rapidly and can last from one to five minutes. They range in severity from a fleeting sense of warmth to a feeling of being consumed by fire “from the inside out.” A major hot flash can induce facial and upper-body flushing, sweating, chills, and sometimes confusion. Having one of these at an inconvenient time (such as during a speech, job interview, or romantic interlude) can be quite disconcerting. Hot flash frequency varies widely. Some women have a few over the course of a week; others may experience 10 or more in the daytime, plus some at night.
Most American women have hot flashes around the time of menopause, but studies of other cultures suggest this experience is not universal. Far fewer Japanese, Korean, and Southeast Asian women report having hot flashes. In Mexico’s Yucatan peninsula, women appear not to have any at all. These differences may reflect cultural variations in perceptions, semantics, and lifestyle factors, such as diet.
Although the physiology of hot flashes has been studied for more than 30 years, no one is certain why or how they occur. Estrogen is involved — if it weren’t, estrogen therapy wouldn’t relieve vasomotor symptoms as well as it does — but it’s not the whole story. For example, researchers have found no differences in estrogen levels in women who have hot flash symptoms and those who don’t. A better understanding of the causes of hot flashes in perimenopause could open the way to new, non hormonal treatments. Hormone therapy quells hot flashes, but it’s not risk-free.
By our late 30s, women don’t produce as much progesterone. The number and quality of follicles also diminishes, causing a decline in estrogen production and fewer ovulations. As a result, by our 40s, cycle length and menstrual flow may vary and periods may become irregular. Estrogen may drop precipitously or spike higher than normal. Over time, FSH levels rise in a vain attempt to prod the ovaries into producing more estrogen.
Although a high FSH can be a sign that perimenopause has begun, a single FSH reading isn’t a reliable indicator because day-to-day hormone levels can fluctuate dramatically.
Perimenopause symptoms
It can be difficult to distinguish the hormonally based symptoms of perimenopause from more general changes due to aging or common midlife events — such as children leaving home, changes in relationships or careers, or the death or illness of parents. Given the range of women’s experience of perimenopause, it’s unlikely that symptoms depend on hormonal fluctuations alone.
Hot flashes and night sweats. An estimated 35%–50% of perimenopausal women suffer sudden waves of body heat with sweating and flushing that last 5–10 minutes, often at night as well as during the day. They typically begin in the scalp, face, neck, or chest and can differ dramatically among women who have them; some women feel only slightly warm, while others end up wringing wet. Hot flashes often continue for a year or two after menopause. In up to 10% of women, they persist for years beyond that.
Vaginal dryness. During late perimenopause, falling estrogen levels can cause vaginal tissue to become thinner and drier. Vaginal dryness (which usually becomes even worse after menopause) can cause itching and irritation. It may also be a source of pain during intercourse, contributing to a decline in sexual desire at midlife.
Uterine bleeding problems. With less progesterone to regulate the growth of the endometrium, the uterine lining may become thicker before it’s shed, resulting in very heavy periods. Also, fibroids (benign tumors of the uterine wall) and endometriosis (the migration of endometrial tissue to other pelvic structures), both of which are fueled by estrogen, may become more troublesome.
Sleep disturbances. About 40% of perimenopausal women have sleep problems. Some studies have shown a relationship between night sweats and disrupted sleep; others have not. The problem is too complex to blame on hormone oscillations alone. Sleep cycles change as we age, and insomnia is a common age-related complaint in both sexes.
Mood symptoms. Estimates put the number of women who experience mood symptoms during perimenopause at 10%–20%. Some studies have linked estrogen to depression during the menopausal transition, but there’s no proof that depression in women at midlife reflects declining hormone levels. In fact, women actually have a lower rate of depression after age 45 than before. Menopause-related hormone changes are also unlikely to make women anxious or chronically irritable, although the unpredictability of perimenopause can be stressful and provoke some episodes of irritability. Also, some women may be more vulnerable than others to hormone-related mood changes. The best predictors of mood symptoms at midlife are life stress, poor overall health, and a history of depression.
Other problems. Many women complain of short-term memory problems and difficulty concentrating during the menopausal transition. Although estrogen and progesterone are players in maintaining brain function, there’s too little information to separate the effects of aging and psychosocial factors from those related to hormone changes.
What to do about perimenopause symptoms
Several treatments have been studied for managing perimenopausal symptoms. Complementary therapies are also available, but research on them is limited and the results are inconsistent.
Vasomotor symptoms. The first rule is to avoid possible triggers of hot flashes, which include warm air temperatures, hot beverages, and spicy foods. You know your triggers best. Dress in layers so you can take off clothes as needed. There’s clear evidence that paced respiration, a deep breathing technique, helps alleviate hot flashes. The most effective treatment for severe hot flashes and night sweats is estrogen. Unless you’ve had a hysterectomy, you’ll likely need to take a progestin to reduce the risk of developing endometrial cancer. Low-dose estrogen by pill or patch — for example, doses that are less than or equal to 0.3 milligrams (mg) conjugated equine estrogen, 0.5 mg oral micronized estradiol, 25 micrograms (mcg) transdermal (patch) estradiol, or 2.5 mcg ethinyl estradiol — works for many women. Other low-dose estradiol-based products include a skin lotion applied to the legs (Estrasorb) and a gel applied to the arms (Estrogel), both available by prescription.
Hormonal irregularities. If you need contraception and don’t smoke, you can take low-dose birth control pills until menopause (see “Irregular periods and heavy bleeding”). Another advantage of these pills is that they regulate your menses and suppress the erratic hormonal ups and downs of perimenopause; some women report feeling more even-tempered while taking them.
Severe hot flashes. Women with severe hot flashes who don’t want or can’t take a hormonal therapy may get some relief from newer antidepressants such as Effexor (venlafaxine) or certain selective serotonin reuptake inhibitors (SSRIs), for example, Prozac (fluoxetine) and Paxil (paroxetine); the epilepsy drug Neurontin (gabapentin); or clonidine, a blood pressure drug. Some of these medications have side effects that may limit their usefulness. Also, some SSRIs can interfere with the metabolism of tamoxifen in certain women.
Irregular periods and heavy bleeding. If you have irregular bleeding and don’t want to become pregnant, low-dose birth control pills are a good choice. By suppressing ovulation, they modulate menstrual flow, regulate periods, and stabilize endometriosis. They also protect against endometrial and ovarian cancers, stave off hot flashes, reduce vaginal dryness, and prevent bone loss. If you have abnormal bleeding, such as daily or very heavy bleeding, see your gynecologist.
Oral contraceptives can be taken until menopause. To help determine whether you’ve reached menopause, your clinician may order a blood test of your FSH level, taken after seven days off the pill. But the only wholly reliable measure is 12 months off hormones without a menstrual period.
Vaginal dryness. Low-dose contraceptives or vaginal estrogen (in a cream, ring, tablet, or gel) can help relieve vaginal dryness, but hormonal treatment is not the only approach. Vaginal moisturizers such as Replens, applied twice weekly, increase vaginal moisture, elasticity, and acidity. Continued sexual activity also seems to improve vaginal tone and helps maintain the acidic environment that protects it against infections. Lubricants such as K-Y Jelly, Astroglide, and K-Y Silk-E can make intercourse less painful.
The estrogen progestrone balance end game and thyroid cancer.
Proliferative thyroid diseases are more prevalent in females than in males. Upon the onset of puberty, the incidence of thyroid cancer increases in females only and declines again after menopause. Estrogen is a potent growth factor both for benign and malignant thyroid cells that may explain the sex difference in the prevalence of thyroid nodules and thyroid cancer. It exerts its growth-promoting effect through a classical genomic and a non-genomic pathway, mediated via a membrane-bound estrogen receptor.
This receptor is linked to the tyrosine kinase signaling pathways MAPK and PI3K. In papillary thyroid carcinomas, these pathways may be activated either by a chromosomal rearrangement of the tyrosine receptor kinase TRKA, by RET/PTC genes, or by a BRAF mutation and, in addition, in females they may be stimulated by high levels of estrogen. Furthermore, estrogen is involved in the regulation of angiogenesis and metastasis that are critical for the outcome of thyroid cancer. In contrast to other carcinomas, however, detailed knowledge on this regulation is still missing for thyroid cancer.
Thyroid may be a small, butterfly-shaped gland, but it takes part in a number of processes in the body. The function of the thyroid gland is influenced by many factors including hormones.One of our previous articles discussed the link between estrogen and thyroid health, but in this post, we are going to focus on a relationship between progesterone and thyroid. How is this hormone connected to the functioning of the thyroid gland?
You’ll find answers below.
Role of progesterone
Progesterone is a female hormone produced by the corpus luteum in the ovary during ovulation or the process when a mature egg is released. The hormone regulates and stimulates numerous functions in the body including ovulation and it plays a vital role during pregnancy[i]. The primary function of progesterone is to prepare endometrium (lining of the uterus) to receive the egg if it gets fertilized by sperm. In instances when an egg isn’t fertilized, progesterone levels decline and cause menstrual bleeding.
During a woman’s pregnancy, progesterone supports the growth of milk-producing glands in the breasts and teenage girls need the hormone for breast development[ii]. Even though the hormone is mainly produced in corpus luteum in the ovary, certain quantities are made by ovaries themselves, adrenal glands, and placenta (during pregnancy)[iii]. Besides its role in pregnancy and female menstrual cycle, progesterone has many other benefits.
The hormone exhibits anti-inflammatory effects, regulates blood pressure, protects bone health, improves mood and reduces anxiety, supports fertility, aids weight loss, among other things[iv]. Sufficient levels of progesterone are necessary for balance in estrogen. Bearing in mind that estrogen has a strong relationship with thyroid health and function, it’s impossible not to wonder how progesterone affects the way this gland operates.
Progesterone deficiency and autoimmune thyroid disease.
Autoimmune thyroid diseases occur when a person’s immune system starts attacking the thyroid and its tissues thus disrupting production of hormones. Two types of autoimmune thyroid disease have been identified: Graves’ disease (the most common cause of hyperthyroidism) and Hashimoto’s thyroiditis (leads to hypothyroidism). Numbers show that rates of Hashimoto’s thyroiditis are increasing each year. At this point, about 3-5 cases per 10,000 people are diagnosed every year. Women are more likely to develop this autoimmune condition with ratio 20:1 compared to men[v].
Why is the prevalence of Hashimoto’s thyroiditis among women so important? That’s because the balance of progesterone and estrogen plays a role in the development of this condition. The journal Endocrine Research published a study which discovered that Hashimoto’s thyroiditis is prevalent among women with polycystic ovary syndrome (PCOS). Polycystic ovary syndrome is a condition that affects women’s hormone levels. Scientists found that women with PCOS had elevated levels of TSH (thyroid stimulating hormone) and low levels of progesterone.
They concluded the study explaining that higher prevalence of Hashimoto’s thyroiditis among women with PCOS could be related to an imbalance of estrogen-progesterone ratio[vi]. Since progesterone deficiency correlates with disturbed thyroid hormone levels, it’s easy to understand that low concentration of this hormone impairs thyroid function.
Progesterone plays a role in estrogen dominance.
The equilibrium between estrogen and progesterone is vital for optimal sexual and overall health and wellbeing. Only when the body contains sufficient amounts of both hormones will the reproductive system and other functions in the body work properly. The relationship between two hormones, i.e. their balance, is crucial for thyroid health too. Evidence shows that estrogen increases the production of thyroid-binding globulin[vii], a protein which binds thyroid hormone and makes it inactive. This leads to decreased metabolism and increased fat deposits.
On the other hand, progesterone decreases thyroid binding globulin and increases the activity of thyroid hormones, when sufficient amounts of this hormone is present in the body. The proper activity of thyroid hormones accelerates metabolism and uses the fat that was stored under estrogen influence for an energy boost[viii]. The equilibrium of estrogen and progesterone is also vital for the prevention of estrogen balance. High estrogen or estrogen balance is a common problem wherein an affected woman can have normal or excessive levels of estrogen, but the insufficient amount or no progesterone.
What’s more, women with low estrogen levels can develop estrogen dominance if they don’t have progesterone in the body. Estrogen dominance urges liver to produce more thyroid binding globulin (TBG). As stated above, enhanced production of TBG decreases the amount of thyroid hormone.
What happens then?
Suppressed production of much-needed thyroid hormones leads to hypothyroidism. Hypothyroidism and estrogen dominance have numerous symptoms in common such as hair loss, weight gain, fatigue, headache, low libido, among others. In fact, thyroid problems can also be a symptom of estrogen dominance[ix] thus confirming the impact of hormone imbalance (low progesterone and high estrogen) on the function of thyroid gland.
Effects of estrogen dominance on thyroid hormones can also extend to mental, not just physical health. Suppressed production of thyroid hormones due to hypothyroidism can contribute or aggravate symptoms of depression. Studies show that hypothyroid women are predisposed to depressive symptoms regardless of socioeconomic and demographic factors[x].
Here’s what exactly happens, production of progesterone declines and the body responds by releasing more estrogen and liver starts pumping out more TBG. In turn, the amount of hormone T3 is limited and becomes unavailable to cells that need it to function properly. The limbic system (brain structures including hypothalamus, amygdala, thalamus, hippocampus etc.) is strongly deprived of T3 and consequences are felt in levels of serotonin and norepinephrine.
As a result, you feel sad, depressed, and uninterested in activities you used to enjoy[xi].
Progesterone receptors in thyroid Hormone fluctuations are natural and they affect everyone, but as you age their levels start to decline. As you know now, progesterone deficiency affects the way thyroid functions. Low levels of this hormone induce estrogen dominance-like symptoms which affect thyroid not only due to TBG levels but because thyroid contains progesterone receptors.
Progesterone receptors bind with the hormone and the gland responds by producing T3 and T4. When progesterone deficiency occurs, the hormone is unable to bind to receptors in the thyroid gland. The result is obvious: production of thyroid hormones decreases and an affected person experiences thyroid symptoms that are very similar to estrogen dominance/low progesterone[xii].
Speaking of progesterone receptors in thyroid, the Journal of Endocrinological Investigation published a study which investigated the role of Vitamin D and progesterone receptors in papillary thyroid carcinoma (PTC). Papillary carcinoma is the most prevalent form of well-differentiated thyroid cancer and the most common type of the disease occurring due to exposure to radiation. A team of scientists from Greece found that vitamin D receptors and protein expression were higher in PTC compared to non-neoplastic thyroid tissue. Progesterone receptors mRNA was increased in 34% participants. Interestingly, findings revealed that progesterone receptors and not vitamin D receptor expression were strongly associated with tumor size[xiii].
Healthy thyroid influences progesterone Throughout this post, we discussed the impact of low progesterone on thyroid function. Every relationship is a two-way street, progesterone and thyroid aren’t the exceptions here. Just like a deficiency in this hormone affects the production of thyroid hormones, this small gland in your neck influences production of progesterone. The Journal of Endocrinology featured a study which found that T3 significantly stimulated the release of progesterone from luteal cells.
That being said, T3 stimulation of progesterone release from luteal cells isn’t direct. Instead, progesterone release is mediated through a putative protein factor[xiv]. Luteal cells are cells from the corpus luteum, an endocrine structure in female ovaries, and the primary location of progesterone production as stated above. In other words, proper function of thyroid gland is necessary for production and sufficient levels of progesterone. Thyroid and progesterone go hand in hand and work properly only when their functions are balanced.
Progesterone is anti-inflammatory.
Inflammation plays a big role in autoimmune conditions affecting the thyroid. Let’s take Hashimoto’s thyroiditis as an example; the term thyroiditis refers to the inflammation of thyroid gland[xv], according to the American Thyroid Association. A growing body of evidence confirms that oxidative stress is a significant mechanism underlying the progress of inflammation. Both conditions (inflammation and oxidative stress) create a vicious circle that affects your entire health and wellbeing. Thyroid hormones protect the body from joint influence of oxidative damage and inflammation due to their antioxidant role.
Of course, this only occurs when production of hormones is sufficient. Hypothyroidism can aggravate oxidative stress and cause a chain of reactions that only increases inflammation and suppresses production of hormones[xvi]. It’s a little-known fact that progesterone exhibits anti-inflammatory effects by suppressing NF-κB (pro-inflammatory signaling protein) and MAPK (contributes to a pro-inflammatory response) activation. Basically, progesterone can attenuate inflammation by inhibiting pro-inflammatory pathways and mediator expressions[xvii].
Getting progesterone levels checked
Due to the importance of progesterone for proper function of thyroid gland, it’s useful get levels of this hormone tested. This is particularly important if you’re experiencing .symptoms associated with thyroid disorders or you’re already diagnosed with a condition affecting this gland. Testing progesterone levels is important for men too.
Why? The hormone is involved in the creation of sperm i.e. spermatogenesis.
In order to check levels of progesterone in your body, the doctor will order a serum progesterone test. The test requires a blood sample of a patient. Before progesterone levels are checked, it’s useful to inform the doctor about medications you’re taking because some drugs may affect the amount of this hormone in your body. Serum progesterone level is measured in nanograms per deciliter (ng/dL). The laboratory analyzes the blood sample and sends results to your doctor.
What is considered to be a normal level of progesterone tends to vary as it depends on a patient’s age, gender, menstrual cycle, pregnancy. Generally speaking, men, postmenopausal women, and women who are at the beginning of their monthly cycle have 1 ng/mL or under. The normal range of progesterone in women who are in the middle of their menstrual cycle is 5-20 ng/mL.
Healthy levels of progesterone in pregnant women depend on the stage of the pregnancy. For example, the normal range of progesterone in the first trimester is 11.2 to 90 ng/mL, in the second trimester, the amount goes from 25.6 to 89.4 ng/mL, while in the third trimester healthy levels of this hormone are between 48.4 and 42.5 ng/mL.
Should I use progesterone?
Women whose hormones are declining have the opportunity to use the bioidentical or synthetic hormone to replenish the loss of progesterone and improve thyroid function.
At this point, there’s no exact evidence that proves efficacy or inefficacy of hormone intake.
If you look online, you’ll notice some sources advise against intake of progesterone while others promote it. The best thing to do is to consult your doctor. Your physician will let you know whether you should take progesterone for better thyroid health.
Conclusion.
Healthy levels of progesterone are vital for your overall health and wellbeing. The thyroid is strongly connected to the concentration of progesterone. At the same time, the hormone depends on the function of thyroid gland because it can stimulate progesterone release. More research is important to uncover the relationship of this hormone and thyroid in full detail. .Relationship Between Estrogen Dominance & Thyroid Disease – Dr Becky Campbell
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