Thyroid and Reproductive Health
The Thyroid Connection to Fertility, Pregnancy and Postpartum
The thyroid and reproductive health go hand in hand. Looking at fertility, pregnancy and the postpartum period, the thyroid is intricately involved and plays a major role in all of these delicate periods. The American Thyroid Association estimates that 1% of pregnancies are affected by overt hypothyroidism (high TSH and low T4) but 15% may be affected by subclinical hypothyroidism. That’s a huge number! What is even more mind blowing is the lack of preconception or even general checking of thyroid status in women of childbearing ages. In recent blog posts, I have discussed the function of the thyroid as well as laboratory evaluation, check them out for more info on thyroid health!
Fertility and the Thyroid
In order to ovulate, we need to have adequate circulating thyroid hormones. If levels are low an egg will not be released from the ovary. Inadequate levels of thyroid hormone can also cause luteal phase dysfunction (the second half of the menstrual cycle) and interfere with egg implantation. In fact, even if thyroid levels are SUB-optimal, they don’t even have to be totally abnormal, a woman can struggle to conceive. Autoimmune thyroid disease can affect fertility even if the TSH is within normal range by disrupting fertilization of the egg, implantation and increasing the risk of miscarriage. The thyroid and reproductive health connection can affect fertility in the following ways:
- Causing menstrual irregularities, making it difficult to conceive
- Interference with the release of an egg from the ovary
- Interference with egg implantation
- Increased risk of miscarriage
My Thyroid Story
As a thyroid patient myself, I know firsthand the frustrations of not feeling well and not getting answers, especially when it comes to the thyroid and reproductive health. I unfortunately found out that the thyroid and fertility go together the hard way when we were trying to get pregnant the second time around.
I was diagnosed with hypothyroidism during my first pregnancy and after this pregnancy my TSH was on a rollercoaster and couldn’t seem to stabilize. We started to try to conceive for baby #2 and at the time my thyroid was within “normal” ranges but on the higher end (my TSH was greater than 4) and we were having trouble getting pregnant. My PCP assured me it was fine and we would get pregnant eventually. This didn’t sit right. I had trained in obstetrics as part of my family practice training and I knew that in pregnancy, we wanted tighter control and more optimal ranges for the TSH so why would trying to conceive be any different?
Thankfully, my OB who I had trained with, confirmed my suspicion, we did in fact want better thyroid control so she increased the dose of my thyroid medication (in line with the 2012 AACE guidelines which recommend a TSH less than 2.5 mIU/L when trying to conceive). A month after the dose adjustment, my TSH was 2.3 mIU/L and another month after that, I was pregnant!
This was the first time I truly knew there had to be a better way and I wanted to know MORE. Why was my thyroid all over the place in the last few years? Was there anything I could do to help it or improve my thyroid function? Was this autoimmune thyroid disease? How may other women who were having trouble conceiving had thyroid dysfunction that was missed?
I had to learn more. Enter Functional Medicine. I have learned SO much about not only the thyroid but how everything is connected to create health and there is no turning back.
Thyroid and Pregnancy
Pregnancy increases the risk for autoimmune thyroid disease and some women will be diagnosed during pregnancy or in the first year following pregnancy with hypothyroidism.
During pregnancy, baby depends on moms thyroid hormones for development of the brain and nervous system until it starts producing its own thyroid hormones around the second trimester. However, baby doesn’t make enough thyroid hormone until about week 18 so it is crucial that mom has an adequately functioning thyroid or has thyroid hormone replacement on board. It is difficult to know if hypothyroidism is occurring during pregnancy unless labs are checked because so many of the symptoms are overlapping with common pregnancy related symptoms, such as fatigue, constipation, trouble with memory or concentration, and muscle cramps. Hypothyroidism in pregnancy is usually caused by autoimmune thyroid disease or Hashimoto’s disease which occurs in 2-3 out of every 100 pregnancies.
Untreated Hypothyroidism during pregnancy leads to an increased risk of:
- Premature birth
- Placental abruption
- Gestational hypertension
- Postpartum hemorrhage
Complications possible to baby from untreated hypothyroidism during pregnancy:
- Preterm birth
- Low birth weight
- Developmental delays
- Congenital malformations
Postpartum thyroiditis is an inflammation of the thyroid that occurs in about 1 in every 20 women during the first year after giving birth (1 in 20, that’s a lot!!). What occurs in postpartum thyroiditis is inflammation in the body triggers thyroid hormone to leak out of the thyroid gland and initially causes an increase in thyroid hormone levels, or hyperthyroidism, which can last up to 3 months. After that, the thyroid gland is damaged and may become under active, or hypothyroid. This may last up to a year and for some women the hypothyroidism doesn’t go away. This is also often difficult or may be not diagnosed due to the overlap in common postpartum symptoms. For the hyperthyroid stage, women feel irritable, anxious, and fatigued but have trouble sleeping. In the hypothyroid stage, again, fatigue, constipation, depression, dry skin, and trouble concentrating or brain fog are all common symptoms experienced during the postpartum period.
This is why I am such a strong advocate for testing women in the postpartum period because it is often missed and women think their symptoms are just a normal part of motherhood.
As you can see the thyroid and reproductive health are so intricately related to fertility, pregnancy and postpartum health. If you find yourself struggling with fertility or in any stage of the postpartum period (this can even be YEARS after baby) and feel like you might have some of these symptoms, book a free 15 minute consultation now to see how Functional Medicine and Wild Rice Wellness can help!