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Writer's pictureMeredith Paci

Hypothyroidism and Its Impact During Perimenopause

Updated: Sep 21

The thyroid is a small, butterfly-shaped gland at the base of the neck that plays a significant role in regulating metabolism, energy levels, and even heart function. When thyroid hormone levels are low, this can affect every bodily process and system, leading to common symptoms like fatigue, weight gain, dry skin, and depression. It can also interfere with cognitive function, which is why people with hypothyroidism often feel mentally foggy or sluggish. And yes, I said every body process—this also includes blood sugar regulation. In some people, this may show up as hypoglycemia, while others could experience high blood sugar levels since hypothyroidism affects metabolism. This ties into insulin production and even receptor sensitivity due to inflammation. We could go round and round about what comes first in this scenario, but sometimes it’s less about pinpointing that and more about understanding the connections to improve what we do know. This thoughtful approach is what separates Fortify Health Coaching.


Contributors to Hypothyroidism


Several factors can contribute to the development of hypothyroidism, many of which are lifestyle-related and build up over time. Subclinical hypothyroidism can go undetected for years—I’ve read anywhere from 7 to 12 years. While the specifics may vary, that’s still a long time. There are a few reasons for this, in my opinion:


  • Many people don’t run lab work. This could be for several reasons:

    • They don’t know they need to or even can

    • They ‘feel fine,’ not knowing they could feel better

    • They don’t want to know, which is totally their right

  • Even when labs are done, it’s common not to see a full thyroid panel, let alone a robust overall workup.

  • And even when lab work is comprehensive, as long as a result doesn’t flag as ‘high’ or ‘low’ per the lab’s ranges, it’s often dismissed. However, many of these ranges are far too broad—like considering an insulin level of under 24 ‘normal,’ which is wildly elevated.


One key contributor is long-term dieting. Repeated cycles of calorie restriction can send the body into a stress state, leading to reduced thyroid hormone production as the body tries to conserve energy. While this might initially seem adaptive, over time, prolonged periods of low-calorie intake can suppress thyroid function. This is especially common in those who have gone through multiple diets or have followed extreme low-carb, low-calorie, or low-energy availability diets for extended periods.


And because I can’t help myself, here’s another nugget: When we talk about stress (which we shouldn’t fear because we need it), high stress from low calories, low carbs, high exercise output, or even stress from feeling like your body isn’t doing what it should can all add up. Did you know that during these stressful times, your body might be pumping out cortisol? Cortisol, a “glucocorticoid” steroid, raises blood sugar to provide you with the energy to fight, flee, or freeze in the face of stress. Yet here you are, fearing food thinking food is the only cause to blood sugar changes. Yowza.


Chronically elevated cortisol also restricts the conversion of T4 to T3 (active thyroid hormone), increases cytokines (think immune response and inflammation), and can affect thyroid receptor sensitivity. It can even disrupt the hypothalamic-pituitary-adrenal axis, which connects your adrenals (where cortisol is produced) and your thyroid. This, in turn, may impact ovarian function—uh oh.


Gut Health’s Role in Thyroid Function


Another significant factor is gut health. The gut and thyroid are closely linked through the gut-thyroid axis, and poor gut health can contribute to thyroid dysfunction. Conditions such as leaky gut, bacterial overgrowth, or chronic inflammation can impair the body’s ability to convert thyroid hormones into their active forms. Additionally, poor absorption of nutrients essential for thyroid health, like selenium and zinc, can further exacerbate hypothyroidism.


Perimenopause and Its Inevitable Role in Women's Health

Perimenopause is the transition period before menopause when hormone levels start to fluctuate even more, leading to metabolic challenges. Irregular cycles and hot flashes are the more obvious symptoms that everyone expects, but even without those symptoms, your body’s internal communication is changing. This goes back to the interactions between the brain, thyroid, adrenals, and ovaries. Every woman will go through perimenopause—there’s no avoiding it. While new medical advancements may evolve in the next few decades, we aren’t there yet.


The relationship between thyroid health and hormone health has always been important, but now the urgency might feel more pressing for some women as they enter perimenopause. While I believe in an “early is better” approach, it's never too late to make an effort.


As estrogen and progesterone shift during perimenopause, they impact the thyroid. Women with hypothyroidism may notice worsening symptoms, making this transition harder. If thyroid health isn’t optimized and prioritized, navigating perimenopause can become more challenging, for all the reasons we’ve already covered.


The Connection Between Hypothyroidism and Hormone Production


Thyroid hormones play a significant role in regulating other hormones in the body. When thyroid hormone levels are low, this can directly affect the production of estrogen, progesterone, and even cortisol. For perimenopausal women, unmanaged hypothyroidism can exacerbate existing hormone imbalances (though the term "hormone balance" is used loosely, as you may have read in other blogs here).


For example, hypothyroidism can lead to an increase in estrogen relative to progesterone—more so than expected during this time. This imbalance can result in heavier periods, more intense PMS symptoms, and a higher risk of estrogen-driven issues. It can also amplify mood disorders such as anxiety or depression, due to the connection between thyroid hormones and neurotransmitters in the brain.


Additionally, low thyroid function can tax/burden the adrenal glands, which produce stress hormones like cortisol. When the thyroid is under active, the adrenals may go into overdrive or if they have been in overdrive for a long period of time they may decided they are getting off this rollercoaster, contributing to the hormonal rollercoaster of perimenopause.


Managing thyroid health is not just about the thyroid itself but about supporting overall health during this critical life stage. This is the approach that we at Fortify recommend.


If you're a coach looking for group support or 1:1 mentorship, or if you're an individual ready to walk a new path, we’re here to help. We offer both 1:1 and group mentorship, as well as consulting services. And for those needing more personal support, coaching options are available. Contact us below to get started!




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