Thyroid and your periods

Have you ever wondered why your gynaecologist asks you to get a thyroid test done when you visit her for menstruation-related problems? Of course, many of you must be aware of thyroid disorders, but did you know that there is a link between your periods and thyroid disorders?

As compared to men, Thyroid disorders are more common in women and the incidence seems to rise with age. Hence, nearly 14%- 26% of women may be having some form of Thyroid disorder by the time they reach menopause. Diagnosing & treating thyroid disorders at an early stage can help many women avoid unnecessary medications and surgeries for menstrual problems. Thus, we really need to be aware of what are the signs & symptoms of thyroid disorders so that diagnosis & treatment can be initiated as early as possible.

All about the thyroid gland

The thyroid gland is a tiny organ in the shape of a butterfly that wraps around the trachea (windpipe) in your neck region. It produces hormones that aid in the regulation of the body’s metabolism & a variety of physiological activities including how quickly you burn calories and how fast your heart beats.

The hormones produced by this gland are:

• Thyroxine or T4
• Triiodothyronine or T3
• Calcitonin

The functioning of the thyroid gland is controlled by another tiny gland, called the Pituitary gland, found in the brain. The pituitary gland secretes a hormone called Thyroid Stimulating Hormone (TSH). As the name indicates, this hormone stimulates the thyroid gland to produce thyroid hormones.

When your thyroid is functioning properly, it continually produces hormones, releases them into the bloodstream, and then produces new hormones to restore the ones that have been lost. This ensures that your metabolism and all of your body's functions are in good working order. The problem occurs when the thyroid gland starts producing too much or too little of the thyroid hormones.

Hypothyroidism (Underactive thyroid)

When the thyroid gland doesn’t produce enough thyroid hormones, it results in a condition known as hypothyroidism or underactive thyroid. As a result, many of your body's activities and your metabolism, are slowed down. It is diagnosed by a blood test to check for T3, T4 & TSH levels. In Hypothyroidism, the level of TSH is high & T3/ T4 is decreased. A person suffering from Hypothyroidism may have any of the following:

• Heavy periods
• Irregular periods
• Difficulty in getting pregnant
• Increased risk of miscarriages, pregnancy complications and developmental defects in the baby
• Release of fluid/secretions from the nipples in a non-pregnant & non-breastfeeding woman
• Fatigue
• Weight gain and difficulty in losing weight
• Constipation
• Muscle pain
• Joint pain
• Intolerance to cold
• Depression
• Dry and scaly skin
• Brittle nails
• Hoarse voice
• Loss of interest in sex
• Tingling or numbness in hands.

Hypothyroidism is a common condition and affects about 4-5% people in the developed countries while the prevalence is almost 10% in India. It is more common in older women, pregnant women & those with obesity. The commonest cause of underactive thyroid is iodine deficiency and the other causes include:

• Hereditary conditions
• Medications such as interferons, amiodarone, and lithium
• Inflammation of the thyroid gland or thyroiditis
• Congenital hypothyroidism , where the thyroid gland is underactive from the birth
• An autoimmune disease known as Hashimoto’s thyroiditis. In this condition, the thyroid is attacked and damaged by the body's own immune system.
• Overtreatment of Hyperthyroidism by medication / radiation or surgical removal of the thyroid gland can also cause hypothyroidism.
• Thyroid cancer

Subclinical Hypothyroidism

When thyroid hormone (T3 and T4) levels are within normal ranges, but the TSH levels are modestly increased, subclinical hypothyroidism (SCH), also known as mild thyroid failure, is identified. If not diagnosed at an early stage, this can develop into overt hypothyroidism.

Hyperthyroidism (Overactive thyroid)

Hyperthyroidism, often known as an overactive thyroid, is a condition in which your thyroid produces more thyroid hormone than the body requires. The level of TSH is decreased & T3/T4 are increased in Hyperthyroidism.

One may miss out on the signs of hyperthyroidism in the beginning. However, gradually a quicker metabolism can lead to the following symptoms:

• Periods are shorter and lighter than usual
• Periods may be delayed or there may be complete absence of periods ( amenorrhoea)
• Difficulty in getting pregnant
• Pregnancy complications
• Increased appetite
• Anxiety
• Rapid heart rate
• Heat intolerance
• Weight loss, despite eating the same or more amount of food
• Diarrhea
• Hand tremors
• Weakness of the muscles
• Bulging, redness, or irritation of eyes

Hyperthyroidism is less common as compared to Hypothyroidism and it can be caused by:

• Grave’s disease, which is an autoimmune disorder.
• Excess of dietary iodine
• Thyroiditis
• Tumors of the thyroid gland

Role of iodine in thyroid function:

Iodine is a mineral that is required for thyroid hormone production. The human body does not produce iodine, so it must be obtained from your food. Food items that are good sources of iodine include iodized salt, seafood, eggs, cheese, yoghurt, etc. You can't generate enough thyroid hormone if you don't have enough iodine in your body.

What is the link between thyroid disorder and menstruation?

Thyroid abnormalities, both Hypo & Hyper thyroidism, are associated with various menstrual problems. This is because thyroid hormones affect the function of ovaries, uterus & the Pituitary gland. Thus, they affect the development & release of the egg from the ovary, the development & growth of the uterine lining ( Endometrium ) and also influence the structure of the uterus & ovaries.

Hypothyroidism (Underactive thyroid) is known to be associated with anovulation, increased levels of circulating estrogens causing increased growth of the uterine lining which leads to delayed & heavy periods in which the blood loss may be more & prolonged. Additionally, the levels of blood clotting factors may be decreased in hypothyroidism , thus leading to increased blood loss during periods.

Hyperthyroidism (overactive thyroid), on the other hand, is associated with irregular ovulation, thinning of the uterine lining , increased levels of circulating progesterone leading to irregular, frequent periods with decreased or scanty blood flow. The blood clotting factors may be increased in people with hyperthyroidism, leading to decreased blood loss during periods. Sometimes, there may be complete absence of periods for many months in women with uncontrolled hyperthyroidism.

Metabolic effects of thyroid disorders

Thyroid problems in general, and hypothyroidism in particular, are significant causes of menstrual irregularities and many metabolic problems in women. The thyroid status of women has a significant impact on menarche, pubertal growth and development, menstrual cycles, fertility and fetal development, postpartum period, reproductive years, and postmenopausal years. So, how does thyroid dysfunction affect menstruation?

• Thyroid disorders interfere with the production and release of two critical female hormones from the Pituitary gland in brain, namely, follicle-stimulating hormone (FSH) and luteinizing hormone (LH). As a result, ovulation is affected by an imbalance of these hormones, which is a significant cause of female fertility issues and irregular periods.
• The weight gain caused by hypothyroidism also puts women at an increased risk of PCOD.
• Thyroid hormones have a substantial impact on glucose metabolism and development of insulin resistance. Hypothyroidism has been linked to insulin resistance, which further increases the risk of PCOD and irregular menstrual cycles.
• The risk of autoimmune disorders such as Hashimoto's thyroiditis is raised in women with PCOD.

Treatment of thyroid disorders

Hypothyroidism: The most common treatment for hypothyroidism is to take daily hormone replacement tablets of levothyroxine. So basically, the medication that you take to treat hypothyroidism is simply an artificial supplement to cover up for the natural thyroid hormone that is being produced in insufficient amount by your body. Once the tablet is taken in, it acts in the same way as the natural thyroid hormone would have worked in your body. However, it is important to remember that it does not cure the underlying cause of hypothyroidism.

Hyperthyroidism: The treatment options available are:

• Anti-thyroid medications such as propylthiouracil and methimazole will decrease the production of thyroid hormones.
• Radioactive iodine: This treatment destroys thyroid cells, preventing them from producing excess thyroid hormones.
• Surgical removal of the thyroid gland, known as thyroidectomy, offers a permanent treatment option for hyperthyroidism.

Dietary restrictions for thyroid disorders

When diagnosed with a thyroid disorder, one has to pay close attention to their diet. Have you heard of goitrogens? Goitrogens are natural chemicals that can be found in a variety of plant-based food items which interfere with the uptake of iodine by the thyroid gland and as such, affect thyroid hormone production. As a result, the thyroid gland overgrows to produce sufficient hormones and forms a Goitre ( which literally means a swelling of the thyroid gland ). Regularly consuming large amounts of these substances may have a negative impact on your thyroid function. Here are examples of food items that contain goitrogens:

• Cruciferous vegetables such as broccoli, cauliflower
• Millet
• Mustard
• Sweet potato
• Peanuts
• Pine nuts
• Radishes
• Red Radish
• Spinach
• Strawberries

So, if you are fond of eating any of the above-mentioned food items and are suffering from hypothyroidism, it’s time to stop consuming these.

Can thyroid disorders be managed naturally?

The best treatment for thyroid disorders is through the medications prescribed by your doctor, however, certain lifestyle & dietary changes may help in better managing the condition & may help you deal with the disorder more efficiently. There are a few steps that you can take to manage your thyroid disorders. These include:

• Diet: Maintain a healthy diet and stay away from packaged food items. Avoid goitrogens if you are suffering from hypothyroidism.
• Never underestimate the power of a good night's sleep. It can do wonders. Try to sleep for at least 7-8 hours daily.
• Maintain a healthy weight.
• Try to set up an exercise routine and be physically active. However, do not overexert yourself.
• Manage your stress levels. Yoga practice is an excellent way to deal with stress. Yoga will help you cope with your symptoms more effectively, but they are not a replacement for medication.