If you have ever experienced the night sweats, insomnia, hot flashes and mood swings, or depression and irritability associated with perimenopause and menopause, you know just how uncomfortable these symptoms can be for you.

Have you been ignoring them because you’re worried about the risks of synthetic hormone replacement options? And are you aware that your thyroid may get caught up in the fray during this time? It’s time more women knew all the related facts that could be affecting their health.

For decades, doctors have prescribed hormone replacement therapy (HRT) to relieve the symptoms of perimenopause and menopause (Surviving and thriving with hormonal changes in menopause).

It’s not uncommon, though, for women undergoing HRT to also be on thyroid replacement therapy because they have an underactive thyroid or hypothyroidism.

So what do you need to know about how the two can interact? Read on to find out all the basics you need to know.

hormone replacement

Why Women Choose Hormone Replacement Therapy Around Menopause

It is normal for women to experience hormonal shifts around the time of perimenopause and menopause.

Perimenopause is the transition period when the ovaries gradually decline in function and make less estrogen. It usually occurs when a woman is around age 40, but it can begin even earlier.

Menopause is the time period when the menstrual cycle stops for at least one year. Onset begins between ages 35 and 55 for most women, but the average age is about 51 years old. Menopause can also take place prematurely if a woman has a hysterectomy.

Key Insight: During either of these times, estrogen and progesterone levels decline significantly because the ovaries stop producing them.

The effect of these hormonal changes include symptoms, such as:

  • Hot flashes
  • Night sweats
  • Mood swings
  • Insomnia
  • Irritability
  • Depression
  • Vaginal dryness

Postmenopause is the stretch of time after menopause when its symptoms cease. It is during this time that the risk of conditions like osteoporosis and heart disease increases.

Bottom Line: It’s during the period between perimenopause and menopause that many women opt to replenish hormone levels with hormone replacement therapy (HRT).

How does HRT work and what does it do? It accomplishes the following:


  • Relieves unpleasant symptoms
  • Prevents heart disease & memory loss
  • Reduces the risk of osteoporosis

Why All The Fuss About The Thyroid?

When a person has hypothyroidism, or an underactive thyroid (Read: What causes thyroid disease), their thyroid gland doesn’t produce enough hormones for the body’s needs. This affects their metabolism and how their body uses energy.

It can ultimately result in symptoms, such as:


Key Insight: Hypothyroidism is the main reason women are prescribed thyroid replacement therapy. This often means taking thyroxine (T4), a precursor to active thyroid hormone and triiodothyronine (T3), the active form of thyroid hormone.

These hormones regulate the energy level of every cell in your body. If there is not enough being produced naturally, it can affect how fast your body burns calories, how rapidly you can think and how fast your heart beats.

Concerned about your thyroid? Here’s a great place to start…

Estrogen Replacement Therapy & Thyroid Function

There are a number of different types of HRT. Let’s begin by looking at HRT that involves estrogen replacement, and how it can interact with your thyroid and thyroid medications.

Key Insight: Thyroid-binding globulin (TBG) is a transport protein that binds with thyroid hormones, reducing their efficacy. Certain medications can increase TBG levels in the blood.

Research has shown that about 5% of postmenopausal women who receive HRT in oral form along with thyroid replacement therapy found it increases thyroxine-binding globulin (TBG), decreasing the amount of T4 (thyroxine) that’s available in the blood.1

These lowered levels of thyroid hormone can trigger symptoms of hypothyroidism in women who are undergoing HRT.

Bottom Line: Women who are taking thyroid medication and are also on hormone replacement therapy should consider getting blood tested more regularly and should be monitored closely in order to make dose adjustment of thyroid medication, especially T4. Your dose may need to be increased. (Read: Are medications hall passes or lottery tickets)

Oral Contraceptive Pill Considerations

Taking birth control pills can also impact thyroid health by increasing TBG, and affecting every cell in your body.2

Another key piece of information many women don’t know is that birth control pills can deplete nutrient status, and increase your body’s requirement for certain minerals and vitamins.3

These include zinc, vitamin C, and magnesium. The B vitamins can also get depleted, which are crucial for your body to be able to process and use thyroid hormone!4

Bottom Line: If you are taking birth control pills, your thyroid dosing may need to be adjusted.5

Natural Hormone Replacement Therapy (NHRT)

Since hormones interact with every cell in your body, they play a critical role in all aspects of your health and wellbeing, including:

  • Your mood
  • Thoughts
  • Emotion
  • Appetite
  • Sex drive

Also, when women are younger and have higher levels of hormones coursing through their blood, they tend to be healthier. Do the hormones help? The simple answer is yes.

When a women’s hormones become imbalanced or significantly decrease, they will turn to hormone replacement therapy to overcome the symptoms of perimenopause and menopause, which include weight gain, hot flashes, mood changes, night sweats, sleep issues, and low libido.

The Use of Hormones Has Sparked Strong Debate

A major study done in 2002 by Women’s Health Initiative reported on animal derived and synthetic hormones (including conjugated equine estrogen and progestin). The study concluded that the health risks involved in taking these substances outweighed the benefits.6

This has led to research into natural hormone replacement therapy, which has drawn attention in recent years.

What is it exactly? It’s an alternative type of hormone replacement therapy made from plant estrogens. They are identical in their chemical makeup to the hormones produced by your bodies.

Compare that idea with what conventional hormone replacement therapy uses: hormones taken from pregnant female horses, plus other synthetic hormones that just do not have the same chemical composition as the hormones that are naturally found within your body.

This is why it’s best to consult with your doctor to discuss the risks and benefits of the therapy they can provide before using any type of hormone replacement therapy.

Bottom Line: Your Integrative Health doctor will be able to tell you if this therapy is a wise option for you, based on your health history. If you start natural hormone replacement therapy, you will be tested and monitored regularly to assess your body’s response to the treatment and ensure everything is going smoothly.

Simple Action Steps To Reduce The Effect Of Interactions

Though the HRT treatments you are considering or undergoing may interact with your thyroid and thyroid medications, there is a lot both you and your doctor at Integrative Health can do to make sure you can enjoy the best level of health available to you.

Let’s begin with some simple action steps…

Inform Your Physician

If you do have a thyroid imbalance at this time, don’t forget to let your doctor know.

Provide your doctor with all the information you can regarding the medications and supplements you’re taking so they can fill in any gaps and ensure you’re receiving all the nutrients you need and your hormones can be balanced effectively.

Regularly Check Your Thyroid

If you are a candidate for HRT, you’re currently undergoing treatment or you’re taking the birth control pill, get your thyroid checked regularly. There are some simple blood tests you should make sure to receive (Read: What type of hormone testing is best for you), including:

  • TSH (thyroid stimulating hormone)
  • FT4 (free thyroxine)
  • FT3 (free triiodothyronine)
  • Thyroid antibodies (thyroglobulin and thyroid peroxidase)
  • TBG (thyroid-binding globulin)

Try Balancing Hormones Naturally

Have you ever noticed that you feel better after a good night’s sleep, when you’re relaxed and when you eat well? This is partly because when you provide your body with what it needs to be in optimum health, it can balance your hormones more easily.

So add in some natural means of balancing hormones. It will aid the efficacy of your treatment.

Make sure to:

  • Get plenty of sleep – At least 7-9 hours per night
  • Manage stress – Try using a daily meditation and exercise program
  • Jumpstart your hormone health – Start with consuming cruciferous vegetables and add in some resistant starch, as well – such as with the Daily Reset Shake (Click here for the shake)

Nourish Your Thyroid With High-Quality Supplements

Your thyroid requires a certain set amount, and variety, of nutrients to thrive – in order to both prevent infections, and produce the metabolism and daily supply of thyroid hormones for your body.

Here are the specific nutrients you will need to supplement with:

Supplement with:

  • Selenium
  • B vitamins
  • Zinc
  • Copper
  • Vitamins A, E & D
  • Magnesium
  • Iron

You’ll also want to get your ferritin (the storage form of iron) levels optimized. Suboptimal ferritin impacts the conversion of T4 to T3.

Our Daily Reset Pack contains a comprehensive mix of thyroid-specific multivitamins if you’d like a convenient supplementation solution…

Daily Reset Packs - Complete Nutrition - Dr. Alan Christianson

Support Your Liver

Your liver is responsible for detoxifying waste and toxins and filtering the blood, but it’s also involved in processing hormones.

Birth control pills have also been shown to affect liver function.7

Thyroid hormones are also converted in the liver and this is why supporting the liver is so important. It could also markedly improve your general health, as the liver is responsible for so many daily tasks related to our general health.

Support your liver by performing a liver cleanse when the seasons change, or twice per year as a minimum.

First, try these simple steps:


  1. Cut out coffee, alcohol, fructose, processed foods and trans fat
  2. Begin taking Liver Detox Supplements, like Liver Love (Click here for Liver Love)
  3. Add in anti-inflammatory and antioxidant foods and drinks to your diet, such as turmeric, blueberries, beets, green tea and dark leafy greens.

Discover The Bigger Picture

Hormone replacement therapy and thyroid interactions can be complex, so always work with a professional, ideally an Integrative Health medical professional, who is well-trained in all the natural solutions you’ll need to balance your hormones and your glands from perimenopause onwards.

With careful management, you can receive enormous benefit from the treatments and supplements you’re prescribed.

If you’d like more information on your particular case or would like to book in for a consultation, please get in touch. Our aim is to allow you to enjoy great health for many decades to come.


1. https://www.ncbi.nlm.nih.gov/pubmed/15142374
2. https://www.ncbi.nlm.nih.gov/pubmed/24438944
3. https://www.ncbi.nlm.nih.gov/pubmed/23852908
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3798926/
5. https://www.ncbi.nlm.nih.gov/pubmed/11396440
6. https://www.ncbi.nlm.nih.gov/pubmed/12117397
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4910851/

Written by Dr. Roz Ranon of Integrative Health. Dr. Roz Ranon, NMD is an Arizona board-certified Naturopathic Physician practicing with Dr. C at Integrative Health with a focus on Hashimoto’s Thyroiditis.

Learn more about Dr. Ranon here