For many women, menopause could feel like an uncontrollable downward health spiral. It can also go hand in hand with Hashimoto’s as the symptoms of both are very similar to one another. The drop in estrogen can tank your mood, motivation, and energy. Your hot flashes rage, and it becomes harder to lose weight the stubborn belly fat. Sensibly, many women get diagnosed for Hashimoto’s as their bodies transition into menopause.
As if this weren’t bad enough, developing Hashimoto’s during menopause can make everything worse. Either on its own is hard enough, but both can be more than double whammy.
The good news is that you’re not alone and there’s a proven way to manage both Hashimoto’s and menopause to feel great, lose weight, and live a full life. In this article, I’ll explain why and how.
Why Hashimoto’s and Menopause Go Hand In Hand
The average age of diagnosis of Hashimoto’s and perimenopause overlap and one can set off the other. Hashimoto’s is typically diagnosed between the ages of 30-50, while perimenopause can start anywhere from the 30s to early 40s.
The menopausal downward health spiral also brings many women on their own health quests, especially when they don’t find answers from conventional medicine. So, menopause is when they tend to finally get diagnosed with Hashimoto’s if it has been lurking under the surface.
Here are three reasons why Hashimoto’s and menopause go hand in hand and tend to worsen each other.
#1 Menopause and hypothyroidism have overlapping symptoms
Both can cause the following symptoms:
- Brain fog and poor memory
- Weight gain
- Joint pain
- Bone and muscle mass loss
- High cholesterol and insulin resistance
- Menstrual irregularities
Therefore, menopause can cause Hashimoto’s to be missed as it’s chalked up to menopause.
#2 Menopausal hormone changes can set off Hashimoto’s
As you age, both estrogen and progesterone go down, but progesterone goes down faster before the ovaries finally stop making estrogen in menopause.
Estrogen stimulates the growth of the thyroid gland and protects your thyroid cells .
Also, progesterone normally increases free thyroid hormone (T4) in the body . Thyroid in turn increases progesterone production by the ovaries. These two hormones work together to support healthy levels of the other.
Estrogen is also an important anti-inflammatory and antioxidant hormone . So, the estrogen drop allows inflammation to go up, which can set off or worsen Hashimoto’s along with many other health issues.
#3 Estrogen fluctuations affects thyroid hormone needs
Clinical studies found that women on estrogen replacement increases the need for thyroid medication in hypothyroid women. Without estrogen replacement, you need less thyroid hormones [5,6].These unpredictable rises and falls in estrogen can make thyroid hormone dosing difficult.
During perimenopause, there are more natural fluctuations in estrogen levels. So, if your thyroid is already struggling and you’ve got the estrogen fluctuations in the mix, it can bring the thyroid issues to the surface.
Therefore, if you are going through menopause and Hashimoto’s, it’s critical to manage both so you can finally feel great and lose weight. Here’s the 6 steps you need to follow.
How to Lose weight with Hashimoto’s during menopause
#1: Get your thyroid hormones under control (optimal)
Many women with Hashimoto’s still have symptoms because they’re only on enough thyroid medications to bring their TSH into the normal range. So, you want to speak to your doctor to adjust your dosages until your thyroid hormones reach optimal range, or a TSH level of .4 – 1.5 mIU/mL.
Many Hashimoto’s patients also benefit from monitoring the entire thyroid panel, including:
- free and bound T3
- free and bound T4
- T3 uptake
- Reverse T3
- Thyroid antibodies
Most conventional doctors won’t test more than TSH and T4 as it doesn’t change their thyroid medication dosage. However, natural treatments and lifestyle changes can affect these other hormones on the full thyroid panel. So, I recommend working with a functional medicine or naturopathic doctor who will test, interpret, and help you optimize your thyroid holistically.
Many menopausal women are also on estrogen and progesterone replacement. Keep in mind to also monitor your thyroid panel and symptoms if you go this route.
#2 Eat an anti-inflammatory diet
Inflammation can worsen both Hashimoto’s and menopause, and food is one (though not the only) source of inflammation. I recommend starting with the autoimmune protocol diet (AIP), which will:
- Eliminate common inflammatory foods and gut irritants
- Cut down toxic chemicals and pesticides in your food
- Eliminate sugar, grains, dairy, and refined foods
- Help you eat better quality foods
- Eating enough protein (30 g per meal) to support muscle growth and blood sugar
These are all necessary changes to reduce inflammation so you can feel better and lose weight.
#3 Lift weights and grow muscles
Aging and Hashimoto’s can contribute to muscle loss, which makes it easier to gain body fat. The muscle loss can also worsen joint pain and overall makes everything worse.
Lifting weights and eating enough proteins can mitigate the muscle loss, and may even help you grow more muscles.
Here are 6 reasons you should focus on strength and growing muscles:
- Muscles burn more calories, making it easier to lose body fat and maintain a higher metabolism as you age
- Your arms, legs, and torso muscles help activate your thyroid hormones. When your thyroid makes the inactive hormone (T4) or you take T4 medications such as levothyroxine, they need to get activated in tissues such as muscles. So, when you have more muscles, you activate thyroid hormones better. 
- Muscles are associated with less total body inflammation.
- Muscles stabilize your joints, reducing joint pain, and keeping you more functional and mobile.
- Resistance training helps with menopausal hot flashes 
- Lifting mitigates the bone mass loss, reducing the risk of fractures 
It may seem counterintuitive and scary to pick up weights if your joints hurt and you’re exhausted. But research confirms that resistance training is the essential medicine to successfully manage Hashimoto’s and menopause.
The problem is that most resistance training programs for non-Hashimoto’s tend to do too much too fast, potentially making your symptoms worse.
After struggling for years, I have finally figured out how to train in a way that helps with Hashimoto’s and guided thousands of women through it. In Thyroid Strong, I teach you exactly how to lift weights and build muscles so you can get stronger, lose weight, and feel better despite your Hashimoto’s and menopause symptoms.
#4 Be careful with ketogenic diets.
Ketogenic diet is the trendy diet right now, especially in people who can’t seem to lose weight in other ways. The ketogenic diet could be beneficial for menopausal symptoms such as hot flashes that originate in the brain.
During menopause, the brain loses its ability to take up glucose so scientists are finding that the menopausal brain cells burn fat from brain components into ketones for energy. So, the menopausal brain may prefer ketones over sugar .
When done right, the ketogenic diet can help with weight loss, blood sugar, cholesterol, and more. But it can also put your body in starvation mode, reducing your thyroid hormone and throwing off your sex hormones . Therefore, if you have Hashimoto’s and menopause, you should be very careful with the ketogenic diet.
Ketogenic is not entirely bad–it has many health benefits. But if you have both Hashimoto’s and menopause, it’s a good idea to cycle in and out of ketosis to prevent the starvation mode from kicking in. Also consider working with a functional medicine doctor to monitor your labs and symptoms on this diet.
#5 Stabilize your blood sugar
Insulin resistance makes hot flashes, night sweats, mood swings, belly fat, inflammation, and everything else worse during menopause [13,14]. Hypothyroidism and low estrogen can also worsen insulin resistance, so it becomes even more important to manage your blood sugar through diet and lifestyle if you have Hashimoto’s during menopause .
The good news is that you can stabilize your blood sugar naturally by:
- Eating more proteins and less carbs
- Focusing on cellular carbs, such as from fruits and vegetables over refined sources such as flour and sugar, if you do eat carbs
- Lifting weights and growing muscles
- Getting enough quality sleep consistently
- Ensuring that you have enough nutrients for blood sugar stability, such as magnesium, vitamin D, omega-3, and chromium
Once you manage your blood sugar well, your menopausal symptoms will also be better managed. You’ll also feel more even-keeled and energized. In many cases, better blood sugar control results in natural fat loss, especially from the midsection.
#6 Manage stress and optimize your sleep
Stress, unaddressed past traumas, and poor sleep make everything worse, especially Hashimoto’s and menopause.
Your stress response axis includes the hypothalamus and pituitary, which controls the adrenals. The adrenals produce cortisol and is the main source of estrogen during menopause. Also, the hypothalamus and pituitary also control your thyroid production. So, stress can dial down your thyroid hormone function .
A big bout of stress can trigger or worsen autoimmunity because it throws off your immune system .
The stress hormones: cortisol, adrenaline, and noradrenaline all increase blood sugar. So, chronic stress can throw off your blood sugar and increase belly fat even if you’re eating a perfect diet. This can worsen hot flashes and all the menopausal symptoms.
Perpetually high cortisol can cost you muscle mass, bone mass, brain tissues, and more.
Poor sleep quality and circadian rhythm will keep your stress responses dysregulated and cortisol high. Traumas, whether you’re aware of them or not, can keep your stress response on high alert and prevent you from healing.
Suffice to say, if you want to get your life back with Hashimoto’s and menopause, there is no way around managing stress, sleeping well, and addressing your traumas. You cannot out-supplement, out-diet, or out-exercise these.
- Finding healthy ways to manage your stress, such as exercise, meditation, and breathing exercises
- Improving your sleep hygiene so you dim the light and wind down 1 – 2 hours before bed
- Working with a professional to address your traumas and re-balance your nervous system
Hashimoto’s and menopause can feel like an awful combination. The good news is that you’re not alone and there’s a proven roadmap that has helped thousands of women like you get their health and physique back. In fact, many of my Thyroid Strong students were in the same boat as you.
You don’t have to figure it all out on your own or struggle to stay motivated to follow through. In Thyroid Strong, you are part of a community of women who share your experience and are walking the walk. We would love to see you there.
Cheers to you and your health,
Dr Emily Kiberd
Affiliate disclaimer: This article contains affiliate links, which means that Thyroid Strong may earn a small percentage of your purchases if you use our links and coupon codes, while the prices will be the same or at a discount to you. This income supports our content production. Thank you so much for your support.
- Santin, A. P. and Furlanetto, T. W. (2011) Role of estrogen in thyroid function and growth regulation. J. Thyroid Res. 2011, 875125.2 Sathi, P., Kalyan, S., Hitchcock, C. L., Pudek, M. and Prior, J. C. (2013) Progesterone therapy increases free thyroxine levels–data from a randomized placebo-controlled 12-week hot flush trial. Clin. Endocrinol. 79, 282–287.
3 Datta, M., Roy, P., Banerjee, J. and Bhattacharya, S. (1998) Thyroid hormone stimulates progesterone release from human luteal cells by generating a proteinaceous factor. J. Endocrinol. 158, 319–325.
4 McCarthy, M. and Raval, A. P. (2020) The peri-menopause in a woman’s life: a systemic inflammatory phase that enables later neurodegenerative disease. J. Neuroinflammation 17, 317.
5 Ben-Rafael, Z., Struass, J. F., 3rd, Arendash-Durand, B., Mastroianni, L., Jr and Flickinger, G. L. (1987) Changes in thyroid function tests and sex hormone binding globulin associated with treatment by gonadotropin. Fertil. Steril. 48, 318–320.
6 Arafah, B. M. (2001) Increased need for thyroxine in women with hypothyroidism during estrogen therapy. N. Engl. J. Med. 344, 1743–1749.
7 Zupo, R., Castellana, F., Sardone, R., Lampignano, L., Paradiso, S., Giagulli, V. A., Triggiani, V., Di Lorenzo, L., Giannelli, G. and De Pergola, G. (2020) Higher Muscle Mass Implies Increased Free-Thyroxine to Free-Triiodothyronine Ratio in Subjects With Overweight and Obesity. Front. Endocrinol. 11, 565065.
8 Tuttle, C. S. L., Thang, L. A. N. and Maier, A. B. (2020) Markers of inflammation and their association with muscle strength and mass: A systematic review and meta-analysis. Ageing Res. Rev. 64, 101185.
9 Berin, E., Hammar, M., Lindblom, H., Lindh-Åstrand, L., Rubér, M. and Spetz Holm, A.-C. (2019) Resistance training for hot flushes in postmenopausal women: A randomised controlled trial. Maturitas 126, 55–60.
10 Hong, A. R. and Kim, S. W. (2018) Effects of Resistance Exercise on Bone Health. Endocrinol Metab (Seoul) 33, 435–444.
11 Klosinski, L. P., Yao, J., Yin, F., Fonteh, A. N., Harrington, M. G., Christensen, T. A., Trushina, E. and Brinton, R. D. (2015) White Matter Lipids as a Ketogenic Fuel Supply in Aging Female Brain: Implications for Alzheimer’s Disease. EBioMedicine 2, 1888–1904.
12 Kose, E., Guzel, O., Demir, K. and Arslan, N. (2017) Changes of thyroid hormonal status in patients receiving ketogenic diet due to intractable epilepsy. J. Pediatr. Endocrinol. Metab. 30, 411–416.
13 Huang, W.-Y., Chang, C.-C., Chen, D.-R., Kor, C.-T., Chen, T.-Y. and Wu, H.-M. (2017) Circulating leptin and adiponectin are associated with insulin resistance in healthy postmenopausal women with hot flashes. PLoS One 12, e0176430.
14 Gray, K. E., Katon, J. G., LeBlanc, E. S., Woods, N. F., Bastian, L. A., Reiber, G. E., Weitlauf, J. C., Nelson, K. M. and LaCroix, A. Z. (2018) Vasomotor symptom characteristics: are they risk factors for incident diabetes? Menopause 25, 520–530.
15 Gierach, M., Gierach, J. and Junik, R. (2014) Insulin resistance and thyroid disorders. Endokrynol. Pol. 65, 70–76.
16 Helmreich, D. L., Parfitt, D. B., Lu, X.-Y., Akil, H. and Watson, S. J. (2005) Relation between the hypothalamic-pituitary-thyroid (HPT) axis and the hypothalamic-pituitary-adrenal (HPA) axis during repeated stress. Neuroendocrinology 81, 183–192.
17 Stojanovich, L. and Marisavljevich, D. (2008) Stress as a trigger of autoimmune disease. Autoimmun. Rev. 7, 209–213.