The Hormonal Symphony: Thyroid, Perimenopause, Menopause, Postmenopause & my 'IM Protocol'

The Hormonal Symphony: how it unravels.

I often use the analogy where I compare the endocrine function (all the hormones secreted in the different organs within our bodies) to a symphony orchestra.

The hormonal homeostasis (balance between the different hormones and their complex functions and interactions) exists as an innate internal rhythm within all our bodies.

It is like a divine melody that is played in perfect synchronicity.

However, the moment one element of the orchestra (hormone) falls out of sync the entire orchestral piece is off-key….eventually the entire symphony falls apart….

Discover my Immune Modulating Protocol, IMP

This first imbalance, usually seen in the thyroid, manifests as one autoimmune dysfunction, eventually leading to a cascade of autoimmune disorders throughout the body….

Our hormone levels oscillate autonomously, synchronising and regulating most biological functions from temperature regulation, sugar levels, brain clarity, energy levels, metabolism, circadian rhythm, mood and much more.

In article below, I will detail mainly the relationship between Thyroid and the steroid hormones, Estrogen and Progesterone. However, it is important to note that our complex hormonal symphony involves other interactions that play a crucial role in the expression/exacerbation of Menopausal symptoms.

Liver:

Poor liver function leads to inadequate conversion from T4 to T3, thus low availability of useful T3, thyroid hormone. Other adverse effects of poor liver function are, suboptimal flushing of Estrogen, blunted liver detoxification pathway, poor Immunity etc. Therefore, a periodic Liver cleanse forms an integral part of my Immune Modulating Protocol (IMP).

Gallbladder:

A poor diet can lead to blocked ducts of the Gallbladder and/or poor secretion of Bile. We need an adequate production of the Bile to offset symptoms like constipation, fatigue, dizziness, weight gain and more.

A diet that includes bitter foods is important. I advocate including all 6 tastes (Ayurveda) in your daily diet. Bitter foods, stimulate bile flow by increasing Cholecystokinin, a hormone that triggers gallbladder contraction.

Adrenals:

The Adrenals can impair thyroid function by triggering autoimmune disease the causes the thyroid to attack itself. I have observed that this usually happens after a stressful life event. Hence, I emphasise the impact of emotional wellbeing and thyroid function.

Foods rich in manganese, selenium, vitamin A and K, aid cell renewal in the Thyroid gland.

Gut lining and Microbiome:

Unhealthy Gut microbiome and poor absorption of zinc and selenium in the gut lining due to IBS, leaky gut etc can lead to deficiencies in these key nutrients needed for conversion of T4 to T3, the usable thyroid hormone .

In a woman’s body, in an ideal world, the hormonal homeostasis between estrogen & progesterone happens naturally throughout the cycle and during the perimenopause and menopause transition.

However, our world is far from ideal: stress, environmental toxins, food additives, pesticides, prescription drugs, digestive issues, food intolerances, and excessive consumption of alcohol and coffee disrupt this delicate rhythm and balance.

Why don't we prepare for this transition to Menopause? Why is this never discussed or promoted?

I observe women entering this transition period to Perimenopause and Menopause with an imbalanced body and mind, with virtually no preparation. It can most certainly feel like an emotional and physical rollercoaster. Often accompanied by an avalanche of distressing symptoms impacting the quality of daily life.

The hormonal transitions that typically begin in a woman in her 40’s, can significantly impact health and well-being, understanding this relationship is crucial.

Preparation includes overhauling the diet and lifestyle in the mid thirties if not earlier. My background in Ayurveda, has demonstrated time and again that an informed holistic approach during key transitions like Menstruation, Fertility, Menopause..is vital if one is to maintain a balanced body and mind.

There is barely any awareness or emphasis on maintaining a balance between the mind, body and spirit. This includes practicing mindfulness, formal breathwork and incorporating strict lifestyle routine and practices, reducing ultra processed foods, sugars, processed carbohydrates, snacking, alcohol, coffee, late nights.

A key finding in a detailed study at King's' College, London confirms my approach that a diet low in carbs, sugars and processed foods in the 30's leads to a smoother, symptom-free transition to Menopause.

https://www.kcl.ac.uk/news/adjusting-diet-can-help-women-through-menopause 

Perimenopause , Menopause, Post Menopause Hashimoto’s and Hypothyroidism.

Let us delve a little deeper into the fragile yet complex relationship between the thyroid and the steroid hormones, mainly estrogen and progesterone in a woman’s body. I will discuss Perimenopause , Menopause, Post menopause Hashimoto’s and Hypothyroidism. The connection between these and how it impacts your health.

‍The average age of diagnosis of Hashimoto’s and perimenopause coincide and one can set off the other.

Symptoms of Hypothyroidism, Perimenopause and Menopause overlap:

• Brain fog & poor memory

• Weight gain

• Sugar cravings

• Fatigue

• Depression

• Poor temperature regulation

• Muscle & joint pain

• Bone & muscle loss

• High cholesterol & insulin resistance

• Poor glycemic control, blood glucose imbalances, susceptibility to T2D

• Menstrual irregularities

• Vaginal dryness

• Low libido

• Hair loss

• Poor sleep

• Systemic inflammation

• Leaky gut

Let us go into a little more detail on: Perimenopause, Menopause and Post Menopause.

Perimenopause, which means ‘around’ or ‘near’ (Latin/ Greek) menopause, is the stage that precedes menopause. Perimenopause typically begins in the mid 40’s. During perimenopause, the body’s production of estrogen and progesterone begins to decline, leading to symptoms such as irregular periods, hot flushes, mood swings, night sweats and sleep disruption. On average, Perimenopause lasts for four years, however, it may last as long as ten years until menstrual periods stop completely.

Menopause is officially completed after one year following the cessation of the last menstrual period. The ongoing decline in estrogen and progesterone levels continue to cause hormonal imbalance-related symptoms for a subset of women into the period known as Post-Menopause.

As we have already discussed all hormones are intertwined in their functions and operate in sync. The hormonal changes during perimenopause, impact the functioning of your immune system, as well as your thyroid gland.

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Hashimoto’s Thyroiditis and Hypothyroidism. Thyroid and its impact during Perimenopause, Menopause and beyond.

The prevalence of thyroid disease, particularly hypothyroidism, is also noticeably higher in women during the perimenopausal and postmenopausal years. It is important to understand that once hormonal imbalances establish as an autoimmune disease/condition like hypothyroidism; this is inevitably followed by other autoimmune conditions in the body… a cascade of inflammation and dysfunction…

Hashimoto’s thyroiditis is an autoimmune disease in which your immune system attacks the thyroid gland, leading to inflammation and a blunting of the function of the thyroid gland, the secretion of thyroid hormones and their function in the body. When the underactive thyroid can no longer produce enough thyroid hormone, the resulting condition is called hypothyroidism.

An underactive thyroid can cause symptoms such as weight gain, depleted energy levels, mood swings, depression and hair loss. The risk of developing both Hashimoto’s thyroiditis and hypothyroidism increases with age. Women are more susceptible to developing thyroid dysfunction.

'I frequently elaborate upon this during my presentations…drawing upon the ancient wisdom of Ayurveda and my understanding of thyroid function.

I recall clearly that during the summer holidays my maternal grandfather, routinely instructed all the little girls in the family to sit on the floor in Padmasana and practice 'Bhramari' (breathwork). The importance of nurturing the Thyroid was drilled in at a very young age.'

The science behind hot flashes, low libido, vaginal dryness and mood swings.

There are various studies that confirm, women with thyroid disorders may be more prone to experiencing menopausal symptoms, such as hot flashes and mood swings. Thyroid hormones play a role in regulating body temperature and mood, any thyroid imbalances will worsen menopausal symptoms.

Low Testosterone especially in Post-menopausal years may impact libido, memory, weight-gain, mood swings, sleep and to some extent cardiovascular health. Testosterone in women, is produced by the ovaries, adrenal glands and the brain, the levels of this hormone decline with age similar to estrogen & progesterone decrease.

My observation with regards to low Testosterone in menopausal women:

• Use of concomitant estrogen replacement exacerbates low testosterone levels

• Switching women with HSDD, to transdermal estrogen can be beneficial and increase the proportion of circulating testosterone

• Testosterone replacement must take into consideration vulvovaginal atrophy, adverse androgenic effects like acne etc

• My instinct is to avoid synthetic hormonal replacement in most cases.

• Including good quality fats in your daily diet shows remarkable improvements in all steroid ( reproductive ) hormone levels

• Consuming adequate protein, lifting weights evidently improves testosterone levels and availability of DHEA.

• Intermittent fasting, Seasonal cleanse & including natural foods rich in Zinc, Glutamine, Vitamin D, lots of sunlight exposure and a daily diet rich in grass-fed meat, eggs, fats, ginger, garlic, oysters... and most importantly a diet low in sugars, processed foods, grains and seed oils help improve liver function which in turn improves circulation of Testosterone

  
  

Estrogen, progesterone and the thyroid hormones:

The relationship between estrogen and progesterone levels and thyroid function is complex, and declining levels of these reproductive hormones during perimenopause can directly affect your thyroid function.

These reproductive hormones help to maintain the balance of thyroid hormones, T4 and T3. Both estrogen and progesterone decline with age, progesterone levels fall faster than estrogen and finally the ovaries stop making estrogen leading to menopause:

• Estrogen stimulates the growth of the thyroid gland and protects the thyroid follicular cells

• Progesterone helps increases free thyroid hormone (T4) in the body

• Thyroid in turn increases progesterone production by the ovaries

Both progesterone & Estrogen decline during the menopause transition (progesterone declines faster compared to Estrogen).

How does declining Estrogen and Progesterone affect the Thyroid?

1) Increased TSH levels

One of the effects of declining estrogen on thyroid function is an increase in thyroid stimulating hormone (TSH) levels. The pituitary gland produces TSH and signals the thyroid to produce more thyroid hormones. When estrogen levels decrease, TSH levels rise, leading to hypothyroidism.

2) Reduced T4-T3 conversion

Another effect of declining estrogen (estrogen-dominance**disproportionate rate of decline between progesterone & estrogen) is a decrease in the conversion of the inactive thyroid hormone thyroxine (T4) to the active thyroid hormone triiodothyronine (T3). This can result in hypothyroidism.

3) Decreased Estrogen

Decreased Estrogen levels can affect the Thyroid antibodies, increasing the risk of autoimmune Hashimoto’s Thyroiditis.

4) Decreased Thyroid-binding Globulin (TBG) production

When estrogen and progesterone levels decline during perimenopause, it can lead to changes in thyroid-binding globulin (TBG) levels. TBG is a protein that binds thyroid hormones in the blood, and changes in TBG levels can affect the levels of free thyroid hormones (T4 and T3) available to cells. Lower levels of estrogen and progesterone can decrease the production of TBG, which leads to an increase in free thyroid hormones (thyroxine or T4 and triiodothyronine or T3) in the bloodstream. This increase in free thyroid hormones can potentially cause periodic surges in thyroid hormones and symptoms resembling hyperthyroidism, such as palpitations, heat intolerance, and mood changes.

5) Estrogen dominance**

This can be caused by poor estrogen elimination by the liver leading to a build-up of ‘used up / unhealthy’ form of estrogen. Estrogen dominance can also be due to progesterone levels being too low to oppose estrogen. These hormone imbalances may manifest as bloating, mood swings, headaches, sugar cravings, low libido, disruptive sleep, breast & ovarian cysts, endometriosis.

Estrogen dominance leads to elevated TSH levels & thyroid antibodies and increases systemic inflammation compromising immunity. This additionally increases anti-thyroid peroxidase, Anti-TPO, contributing to autoimmune Hashimotos...

Estrogen dominance** in turn stimulates a spike in the stress hormone Cortisol. High cortisol levels are associated with increased inflammation, poor gut microbiome, leaky gut, metabolic disease, sugar cravings and triggering the thyroid to attack itself.

6) Estrogen, progesterone, and autoimmunity

The effects of declining estrogen and progesterone during perimenopause on autoimmune diseases can vary. But in general, changes in estrogen and progesterone levels during perimenopause may increase thyroid antibodies and systemic inflammation. Thus, impact the onset, progression, or symptoms of autoimmune diseases like Hashimoto’s thyroiditis.

Do declining levels of Estrogen and Progesterone contribute to onset of Autoimmune diseases in an already unhealthy and imbalanced body?

Here are some general effects that declining estrogen and progesterone levels during perimenopause can have on autoimmune diseases:

1) Increased inflammation

Both estrogen and progesterone have anti-inflammatory effects, and the decline in these hormones during perimenopause may lead to increased inflammation and immune activation. This could potentially worsen symptoms and trigger increased disease activity in some autoimmune conditions.

2) Worsening of symptoms

Estrogen may play a role in the development of autoimmune diseases, and its decline during perimenopause could potentially influence the risk of developing new autoimmune conditions or trigger the onset of symptoms in susceptible individuals. In some cases, the decline in progesterone levels during perimenopause may also trigger flare-ups or worsening of symptoms in individuals with autoimmune diseases. This could be due to increased immune activity or changes in the expression of autoimmune-related genes.

3) Imbalanced immune regulation

Estrogen and progesterone are involved in regulating the balance of immune responses, including the balance between pro-inflammatory and anti-inflammatory responses. Changes in these hormone levels may disrupt this balance, potentially affecting immune regulation in individuals with autoimmune diseases.

The relationship between: Estrogen fluctuations, HRT & Thyroid:

Various clinical studies indicate that women who are on thyroid replacement medication & subsequently go on estrogen replacement will inevitably have to increase thyroid medication. The unpredictable rises and falls in estrogen during this transition period can make thyroid hormone dosing difficult.

How to navigate the hormonal changes?  

With an informed approach & experienced professionals, women can navigate perimenopause, menopause and thyroid dysfunction with minimal symptoms whilst maintaining the best possible quality of life. I will share my successful and carefully designed immune modulating protocol for you to use.

My approach includes: prescription medication and my established Immune Modulating Protocol (IMP).

Prescription Medication

Prescription medication; I appreciate that in the short term, for some women, hormone replacement therapy (HRT) can help alleviate perimenopausal and menopausal symptoms and potentially modulate immune function, thereby influencing autoimmune activity. The decision to use HRT should be made on an individual basis, carefully considering potential risks and benefits. It is important that we do not ignore the impact of prescription medication like HRT, proton pump inhibitors, antibiotics, OCT painkillers etc. on absorption of nutrients like magnesium.

Ref my video on magnesium. https://www.vedantnutrition.com/post/magnesium-an-insight

Prescription medication adversely affects the gut lining and gut microbiome (bacteria).

In cases of overt hypothyroidism, thyroid replacement hormones are often necessary to regulate thyroid hormone levels, but it is important to acknowledge that this comes at a price: compromised nutrient absorption...

Crucially, I want you to pay attention to the fact that regular monitoring of thyroid function is vital – via testing of key biomarkers. It is crucial to ensure adequate dosing, especially during the hormonal shifts of perimenopause and menopause.

Thyroid function testing should measure TSH, T4, T3, and thyroid peroxidase (TPO) and anti-TPO antibodies to help diagnose any underlying thyroid disorders.

My Immune Modulating Protocol (IMP) 

My established Immune Modulating Protocol (IMP) includes the following:

1) Lifestyle modifications

A healthy lifestyle can be pivotal in managing symptoms and improving quality of life. This includes a regular, regimented daily routine, a fresh diet rich in anti-inflammatory foods, regular physical activity, stress management techniques, self-care and a regulated circadian rhythm. Additionally, avoiding environmental triggers that disrupt hormonal balance and immune function, such as endocrine-disrupting chemicals, plastic food containers, synthetic clothing, chemicals in cosmetics, pesticides in food and more…

2) Immune modulating diet, IMP

I find that some women achieve symptom relief by consuming specific foods that aim to reduce inflammation and autoimmune responses.

Firstly, eliminate potential food triggers, the usual gut irritants like ultra processed foods, sugar, sweeteners, bulking agents, PFA’s, soy based foods & beverages, night shades, goitrogens like cruciferous vegetables cabbage, turnip, kale etc, seed oils, processed dairy, low fat , low sugar substitute foods, phytates in seeds & spices, oxalates in green leafy vegetables and more…

3) Daily routine

Be ready to establish a brand new relationship to foods, meal times, fasting and a holistic approach to daily routine and emotional wellbeing. Here are my favorite Asanas, especially important during the perimenopause and beyond. *Along with, Pranayama & Yoga Nidra lifting weights is essential to forge a stronger mind body and spirit connection.

4) Supplementation

I do not recommend synthetic supplements, they can be damaging in their own way.

However, there are instances where supplementation is essential, choose pure, organic supplements free from bulking, caking agents & chemicals.

Ensure you derive adequate vitamins & minerals from your fresh, seasonal, homemade diet: iron, magnesium, selenium, zinc, vitamin D, Vitamin B complex, vitamin B1, vitamin B-12, probiotics, l-tyrosine, glycine and omega-3, can support the thyroid, aid hormonal balance and immune health.

5) Hormone re-balance

I employ two approaches: Food-cycling & Seasonal Liver cleanse

An important part of my IMP is Food Cycling and Liver Cleanse.

Perimenopausal and Menopausal women may start the food-cycling on any day and follow the same 2-week rotation plan. Since levels of estrogen and progesterone naturally decline during menopause, food-cycling can provide extra support to alleviate symptoms associated with lower hormone levels.

Food-cycling may minimise the impact of hormone fluctuations, particularly in perimenopause, by reducing hot flashes and mood swing, and improving energy levels and sleep quality.

Women experiencing amenorrhea (absence of periods) may also benefit from seed cycling by starting the 2-week cycle at any time.

This carefully planned food-cycling can reduce sugar cravings, support healthy cholesterol levels and reduce inflammation. You may quickly see an improvement in your energy levels, find your skin is glowing and your hair shining.

Avoid heavily processed foods, alcohol, excessive caffeine, spicy foods, seed oils and sugar as these can contribute to inflammation.

Hormonal re-balance Food-cycling; Phase I - two weeks:

Consume protein rich foods, rich in minerals and healthy fat:

• Chicken, Eggs

• Trout, Shellfish

• Pork

• Flaxseeds, Pistachio & Pumpkin seeds

• Pomegranate, Beets, Berries, Grapes, Papaya

• Seaweed

• Lentils, Mung beans

• Fermented foods

These foods support the estrogen dominant phase 1, (two weeks).

Hormonal re-balance Food-cycling; Phase II - two weeks:

Consume lighter, mineral rich proteins:

• Salmon, tuna, white fish

• Lamb, red meat, turkey

• Sesame & sunflower seeds

• Red lentils, Chickpeas ( in moderation)

• Berries, grapes

• Cooked Spinach, dandelion

• Apricot, cantaloupe, fig, berries

• Apple, date, pear, peach

• Organic cacao, coffee (in moderation)

• Garlic, ginger, onion, cashew nuts, oysters (testosterone balancing)

• Sweet potato, fresh mint, coriander

These foods support phase 2, when progesterone dominates the luteal phase, (two weeks).

Seasonal Liver Cleanse:

7 Days during both Spring and Autumn

Every Morning on an empty stomach:

• 1/2 tsp of organic Olive oil

• 1/2 tsp of freshly squeezed lime

• A large pinch of organic Cayenne Pepper

Lower body exercises once/daily

Routine Gut repair & Reset:

This is designed on an individual basis.

Your future is bright…

With IMP, I encourage you to disband old habits and behaviours and embrace your inner light…your physical body is but an extension of the Panchamahabhutas that make up every atom in our Cosmos. Allow nature to rebalance & nurture.

My philosophy & training lead me to view menopause as not only a natural transition in a woman’s life but as a sacred time when her accumulated life-wisdom helps foster a stronger mind-body connection.

Menopause represents a renewal of energy and opportunities, passion and self-awareness.

Love, Embrace, Breathe, Meditate, Chant, Sing, Pray, Create, Cook, Paint, Write Poetry….find your inner peace and harmony. Align your mind-body-soul.

It works every time!!!

‍Refrences:

Biochemistry, 1987.

Brooks, Jennifer D., et al. “Supplementation with Flaxseed Alters Estrogen Metabolism in Postmenopausal Women to a Greater Extent than Does Supplementation with an Equal Amount of Soy 1-3.” American Journal of Clinical Nutrition, 2004.

Brzezinski, Amnon, and Ayelet Debi. “Phytoestrogens: The ‘natural’ Selective Estrogen Receptor Modulators?”

https://www.kcl.ac.uk/news/adjusting-diet-can-help-women-through-menopause