Hashimotos & Treating Menopause without Estrogen

Menopause Hashimotos

As you know, the most common symptoms of menopause are hot flashes / night sweats, osteoporosis and vaginal dryness which are all associated, at least in part, with estrogen deficiency. If saliva hormone testing confirms that you are low in estradiol, one option is to prescribe Bi-Est, a combination of two bioidentical estrogens: estriol and estradiol. However, estrogen therapy is not an option for a lot of women especially if the genetic SNP known as COMT is an issue. With COMT, the body can’t break down estrogen. This is a relatively new discovery, and I’m testing all of my clients for this and other gene SNPs via a methyl detox profile.  The good news is that in many cases, treating menopause without estrogen is possible. Even if you cannot use estrogen, there are many other ways you can address these sometimes debilitating symptoms.

Are Your Symptoms Hashimoto’s or Could it be Menopause?

For many women, it is sometimes difficult to know which came first, menopause or Hashimoto’s?

Menopause makes the symptoms of Hashimoto’s worse and vice versa. Sometimes, it is during menopause when a woman initially discovers that she also has autoimmune thyroid disease.

Believe it or not, the symptoms of both are very similar:

  • weight gain
  • increased fat and cellulite along with decreased muscle mass
  • increased stress
  • decreased stamina
  • overwhelming fatigue
  • tiredness – feeling like you need a nap all the time
  • muscle & joint aches & pains
  • mood changes
  • difficulty sleeping
  • decreased libido
  • foggy brain
  • and all the other common symptoms we ladies often discuss as being menopause-only symptoms

Hot Flashes / Night Sweats

Hot flashes are mostly caused by the hormonal changes of menopause, but can also be affected by lifestyle and medications. Diminished levels of estrogen and progesterone have a direct effect on the hypothalamus, the part of the brain responsible for controlling your appetite, sleep cycles, sex hormones and body temperature. The drop in hormones confuses the hypothalamus, also referred to as the body’s thermostat and makes it read “too hot!”

The brain responds to this report by telling the heart, blood vessels and nervous system to lower the heat immediately! The message transmitted almost instantly by the nervous system’s chemical messenger (epinephrine), and additional compounds: norepinephrine, prostaglandins, and serotonin. The heart pumps faster, the blood vessels in the skin dilate to circulate more blood to radiate off the heat and the sweat glands release sweat to cool the body.

This heat-releasing mechanism is also how the body keeps from overheating in the summer but when the process is triggered instead by a drop in estrogen, the brain’s confused response can make you VERY UNCOMFORTABLE.

Natural Treatments for Hashimoto’s and Menopause

  • AVOID TRIGGERS: Alcohol, caffeine, diet pills, sugar, stress, spicy foods, hot food, hot tubs, saunas, hot showers, hot weather and smoking can all trigger and exacerbate hot flashes.
  • EXERCISE: There is evidence to support that regular exercise can help to deter hot flashes, and women who work out report that they get fewer episodes than sedentary women. One theory is that exercise raises levels of endorphins. Not coincidentally, there is some evidence to show that endorphins are involved in the regulation of body temperature; thus, the higher their levels, the more reliable the body’s internal thermostat may be. However, exercise within 3 hours of going to bed should be avoided to help prevent night sweats.
  • STRESS MANAGEMENT: Some women find relief through meditation, biofeedback, slow abdominal breathing and other stress reducing techniques.
    • It has been shown that over time, a low-fat diet may decrease hot flashes in some women. Others find a low-fat diet exacerbates their symptoms including weight gain. As a nurse-nutritionist, I recommend an anti-inflammatory diet based on your unique food sensitivities with a focus on organic antioxidant-rich fruits and vegetables, pastured and grass-fed poultry and beef, wild caught salmon and healthy fats such as extra virgin olive oil, coconut oil, avocado, Ghee and nuts/seeds.
    • Green tea is especially rich in phytohormones and antioxidants. Research has shown that women who drink either green or black tea consistently have stronger bones than those in a control group!
    • Caffeine: high levels of caffeine in the form of coffee or soda, upsets the natural balance of calcium and phosphorus and causes calcium excretion in urine. Not to mention, caffeine is hard on the adrenal glands.
    • Carbonated beverages such as cola may contain as much as 500 mg of phosphorus per serving and should be avoided as too much phosphorus can deplete bones of calcium.
    • Green leafy vegetables: these are healthy dietary sources rich in calcium and include: broccoli, Brussels sprouts, collards, kale, mustard greens Swiss chard, spinach. Be sure always to lightly steam or cook cruciferous veggies to protect the thyroid.
    • Progesterone: A double-blind study using progesterone cream for the treatment of hot flashes was published in the journal Obstetrics and Gynecology in 1999. The study showed that hot flashes improved in 83% of women using progesterone cream, while only 19% of women using a placebo got relief.
    • DHEA: A Norwegian study published in the journal Maturitas, measured hormone levels in postmenopausal women suffering from hot flashes and found that low testosterone and DHEA levels were significantly associated with hot flashes and that normal or high levels of these hormones protected against hot flashes. In many cases, DHEA supplementation may be sufficient, as up to 50% can convert to testosterone.

    • Vitamin E (400-800 IU) may reduce the occurrence and severity of hot flashes and night sweats during menopause or perimenopause, and provides additional benefits of strengthening the immune system and protecting the heart.
    • B vitamins, vitamin C, magnesium citrate and potassium supplementation may be beneficial as hot flashes deplete these nutrients in the body. The enzymes that incorporate calcium into the bone require magnesium and B6 as co-catalysts. If magnesium and B6 are deficient, calcium is less likely to become bone and is more likely to appear as calcification of tissues and joints. Calcium should be obtained from foods such as green leafy vegetables. Almond milk is also a great resource for calcium. The recommended dose of vitamin B6 is 50 mg twice per day.
    • Zinc picolinate: is an essential co-catalyst for numerous enzymes including those that convert beta-carotene to vitamin A within the cells – especially important in building the collagen matrix of cartilage and bone. Additionally, zinc assists in the absorption of vitamin D and calcium and is required for the proper formation of bone cells. The recommended dose is 15-30 mg daily. 30 mg is recommended for leaky gut syndrome and celiac disease.
    • Vitamin D3: start with 1,000 to 2,000 IU daily. Vitamin D is essential for bone building. It facilitates calcium and phosphorus transport from the intestine into the blood.
    • Essential Fatty Acids: A Swedish study looked at the fatty acid composition of the serum of 78 healthy individuals and measured their spine, hip, and whole-body bone mineral density (BMD). A clear link between the omega-3 content and the participants BMD levels was noted. Higher ratios of omega-6 to omega-3 fatty acids were linked to lower spinal BMD.
    • Evening Primrose Oil (500 mg three times per day) is an excellent source of gamma-linolenic acid (GLA) that is a precursor to anti-inflammatory prostaglandins. Use of Evening Primrose Oil has been shown to reduce nighttime flushing.
    • Black Cohosh (40-80 mg daily) can provide relief from hot flashes as well as other menopausal symptoms including headaches, heart palpitations, and anxiety. At least 4-12 weeks of treatment may be required before therapeutic benefits are seen.
    • Ground flaxseeds & flax oil: in addition to increasing the levels of a lab marker called Sex Hormone Binding Globulin (SHBG) which can help in balancing hormones, flax may have estrogen-like effects because of the lignans (phytoestrogens) they contain. Two tablespoons of flax oil per day also help to increase short-chain fatty acids.

Vaginal Dryness

There is a thin layer of moisture that coats the vaginal walls. As women age, hormonal changes affect the amount and consistency of this moisture. Vaginal dryness is a common problem during menopause (due to decreased estrogen levels), although inadequate vaginal lubrication can occur at any age. Symptoms of vaginal dryness include itching and stinging, pain and irritation from clothing.

Dr. John Lee observed that, in his patients who could not use estrogens, natural progesterone therapy often relieved their symptoms of vaginal dryness. He noted that for many women, their previous vaginal dryness and reduced mucus production returned to normal after 3-4 months of topical progesterone use.

General Recommendations for Vaginal Health

  • Probiotics The vagina is a finely balanced ecosystem and taking oral probiotics can help to maintain that delicate balance.
  • Vitamin E can be used vaginally to moisturize the tissues. There is no need to break open the capsule, as the pH of the vagina will degrade it.
  • Vitamin A (10,000 IU daily) helps to maintain overall tissue integrity of skin and mucous membranes.
  • Hydration: Adequate water intake is imperative for the production of all body secretions.
  • Kegel exercises: In many cases, regularly performing Kegel exercises may increase circulation to the pelvic floor and assist in maintaining tissue tone.
  • AVOID: Douching, soaps, and bubble baths as these can increase dryness and irritate sensitive vaginal tissue.


  • Dressing in layers that can be peeled off as you get warmer…
  • Wearing natural, breathable fibers such as cotton and linen and avoiding wool, silk, and synthetic fabrics…
  • Wearing shirts with an open neck and loose clothing…
  • Keeping cool water or beverages nearby for sipping…
  • Keeping a small portable battery-operated fan on your nightstand…
  • Lowering the thermostat whenever possible…
  • Wearing cotton p.j.’s or nightgowns to bed – after a night sweat, nightclothes is easier to change than sheets…
  • Sleeping on cotton sheets…
  • Investing in a bigger bed if sleeping too close to your beloved creates excess heat (or send hubby to the guest bedroom, lol!)…
  • Taking a cool shower before bed…
  • Maintaining blood sugar balance throughout the day and before bedtime…
  • Applying peppermint oil to the abdomen and soles of feet before bedtime is cooling…
  • Deep breathing when you feel a hot flash “coming on” helps to derail the intensity by lowering the thermostat quicker…

Do you struggle with the symptoms of menopause? Has it made living with Hashimoto’s even more challenging?  Let me know what your greatest challenge is and what I can do to help!