Many women with Hashimoto’s are told to focus on gut health, stress management, and infections as triggers. While these factors are important, there’s one major piece of the puzzle that often gets ignored: hormones, specifically estrogen.
For women over 35, hormone fluctuations can significantly impact immune function, metabolism, and thyroid health. In this episode, Dr. Felice Gersh, a dual board-certified OB/GYN and Integrative Medicine physician, founder and director of the Integrative Medical Group of Irvine, best-selling author of the PCOS SOS series and Menopause: 50 Things You Need to Know, and global lecturer on women’s health, shares important insights into the connection between estrogen, immune modulation, and Hashimoto’s.
Why Women Are More Prone to Autoimmune Diseases
It’s no coincidence that 80% of all autoimmune conditions affect women. As Dr. Gersh explains, this is due to a combination of factors:
- The X Chromosome Factor: Women have two X chromosomes, and during embryological development, both are briefly active before one is inactivated. However, about 15% of immune-related genes on the inactivated X chromosome remain active, contributing to a stronger and more responsive immune system in women.
- Estrogen’s Role in Immune Regulation: Estradiol (E2), the dominant estrogen in reproductive years, directly influences the immune system, helping to modulate inflammation and prevent immune overreaction by regulating immune cell activity and cytokine production. It plays a dual role—stimulating immune function when necessary while also preventing excessive inflammatory responses that could trigger autoimmunity.
- Pregnancy’s Immune Shift: During pregnancy, the body produces high levels of estriol (E3), a protective form of estrogen that helps calm the immune system and reduce inflammatory responses. This shift is crucial in preventing the maternal body from attacking the fetus. Many women with autoimmune conditions experience remission during pregnancy due to this immune regulation, but flare-ups postpartum when estrogen levels drop dramatically and the immune system rebounds.
PCOS, Puberty, and the Early Onset of Hashimoto’s
One of the most alarming trends Dr. Gersh highlights is the increasing number of young girls being diagnosed with Hashimoto’s in childhood and adolescence—sometimes as early as age 8 or 9. This is closely linked to endocrine disruptors, early hormonal imbalances, and conditions like PCOS (Polycystic Ovary Syndrome).
How Early Hormonal Disruptions Increase Autoimmune Risk
- In Utero Exposure to Endocrine Disruptors: Many girls develop hormone imbalances before birth due to exposure to BPA, phthalates, and other hormone-disrupting chemicals passed from mother to fetus. These disrupt normal estrogen receptor function, increasing the risk of PCOS, metabolic issues, and immune dysregulation.
- Early Puberty and Immune Confusion: The rise in early puberty—triggered by environmental factors like artificial light exposure and nutritional changes—can lead to hormonal chaos in young girls. Increased cortisol and insulin resistance can drive inflammation, gut dysbiosis, and immune dysfunction, setting the stage for Hashimoto’s.
- PCOS and Estrogen Receptor Dysfunction: Girls with PCOS often have estrogen receptor imbalances that impair the body’s ability to regulate inflammation. PCOS is now understood to be not just an ovarian disorder, but a whole-body condition that increases the risk of autoimmune diseases, including Hashimoto’s.
Young girls with early puberty, irregular periods, metabolic issues, or PCOS symptoms should be evaluated for immune dysregulation and thyroid function. Identifying hormonal imbalances early can help prevent the onset of full-blown autoimmune disease later in life.
The Gut-Hormone Connection: How Estrogen Influences Immune Regulation
One of the most overlooked aspects of Hashimoto’s and autoimmunity is the intricate relationship between estrogen and gut health. As Dr. Gersh explains, estrogen plays a direct role in modulating the gut microbiome and maintaining the gut lining, both of which are essential for immune balance.
How Estrogen Affects the Gut and Immune Function
- Supports a Healthy Gut Barrier: Estrogen helps maintain the integrity of the intestinal lining, reducing leaky gut, a known trigger for autoimmune diseases.
- Regulates Gut Microbiome Diversity: Lower estrogen levels disrupt the balance of gut bacteria, increasing the presence of inflammatory microbes that can trigger immune overactivity.
- Reduces the Risk of Molecular Mimicry: When the gut barrier is compromised, toxins and bacterial byproducts enter the bloodstream, confusing the immune system and leading to attacks on the thyroid.
Perimenopause, Hashimoto’s and Autoimmune Disease
Most women don’t realize that perimenopause can begin in the mid-30s to early 40s, well before menopause. Since estrogen plays a major role in immune balance, its decline can make Hashimoto’s symptoms worse.
Early Signs of Perimenopause That Overlap with Hashimoto’s:
- Unexplained weight gain (especially around the midsection)
- Fatigue and brain fog
- Changes in skin elasticity and collagen loss
- Increased inflammation and joint pain
- Worsening thyroid symptoms, despite medication
Dr. Gersh suggests that every woman do a menstrual map based on her mother’s history and any signs of symptoms that signal perimenopausal changes. She also says that balancing hormones properly can help modulate immune function, reduce inflammation, and support Hashimoto’s management.
Why Women Feel Like Their Body Changes “Overnight”
Dr. Gersh highlights that many women express frustration over sudden weight gain and metabolic changes, despite maintaining the same diet and lifestyle. This shift is largely due to hormonal changes, not just calorie intake or exercise habits. Estradiol also influences cortisol production, appetite control, and fat storage, further complicating weight management for women with Hashimoto’s.
Here’s how estrogen affects fat metabolism and autoimmune health:
- Regulates Mitochondria and Fat Burning: Estradiol helps modulate mitochondrial activity, promoting efficient energy production and fat burning. When estrogen levels drop, the body becomes less efficient at utilizing fat for energy, leading to weight gain.
- Controls Glucose Transport and Insulin Sensitivity: Estrogen helps regulate glucose metabolism. Its decline can contribute to insulin resistance, a known driver of inflammation and autoimmune activation.
- Impacts Gut Health and Immune Response: Lower estrogen levels disrupt gut microbiome balance, leading to leaky gut, increased inflammation, and immune dysregulation—all of which exacerbate Hashimoto’s symptoms.
Dr. Gersh’s Approach to Hormone Supplementation for Autoimmune and Thyroid Health
One of the key takeaways from this episode is Dr. Gersh’s approach to hormone replacement therapy (HRT) as a tool for immune regulation and overall health optimization, rather than just a way to suppress symptoms like hot flashes.
Why Hormone Replacement Is About More Than Just Symptom Management
- Many doctors only prescribe HRT when a woman experiences severe menopausal symptoms, such as hot flashes or night sweats. Dr. Gersh argues that this overlooks the critical role estrogen plays in maintaining immune balance, gut health, metabolism, and brain function.
- Estradiol directly modulates immune function, meaning that declining estrogen levels can increase inflammation, worsen autoimmunity, and make Hashimoto’s symptoms harder to manage.
- Women with suboptimal hormone levels (even before full menopause) may experience metabolic shifts, increased fatigue, and autoimmune flares—all of which can be mitigated with the right hormone support.
Dr. Gersh’s Preferred Methods for Hormone Supplementation
- Estradiol should always be given transdermally (via creams, gels, or patches) rather than orally. Oral estrogen first passes through the liver, which alters its form and increases clotting risks.
- Pellets are not ideal because they deliver inconsistent doses over time, leading to peaks and crashes that don’t mimic the body’s natural hormonal rhythms.
- Progesterone should be cycled rather than taken daily. Continuous progesterone use can downregulate estrogen receptors and lead to less effective hormone balance over time.
- Dosing should be based on lab testing to ensure optimal levels. Just as doctors optimize thyroid hormone replacement, estrogen and progesterone should be adjusted based on actual levels and symptoms.
Dr. Gersh emphasizes that hormone optimization is key to preventing long-term health issues, such as osteoporosis, cardiovascular disease, and cognitive decline—all of which are more common in women with Hashimoto’s.
The Bigger Picture: Balancing Hormones, Thyroid Health, and Autoimmune Regulation
This was a longer episode and a little different than many of the past episodes but Dr. Gersh provided so much value, that I just had to include it all (and hope to bring you a part 2 with Dr. Gersh!). There are so many things at play when it comes to Hashimoto’s and your hormones. As Dr. Gersh explains, hormones and autoimmunity are deeply interconnected, and thyroid health cannot be separated from the broader endocrine system. Whether a woman is experiencing perimenopause, Hashimoto’s, or PCOS, understanding and addressing estrogen balance is crucial.
Key Takeaways from This Episode
- Women are more prone to autoimmunity due to the way estrogen modulates immune function.
- Declining estrogen levels can trigger immune dysregulation, gut issues, and metabolic changes that worsen Hashimoto’s symptoms.
- Perimenopause often begins in the late 30s to early 40s, and hormonal shifts during this time can make Hashimoto’s harder to manage.
- Hormone supplementation, when done correctly, can help stabilize the immune system, reduce inflammation, and support thyroid function.
- Environmental toxins (endocrine disruptors) play a major role in hormonal imbalances and autoimmune disease, which is why reducing exposure to plastics, pesticides, and synthetic fragrances is essential for Hashimoto’s management.
Taking Control of Your Hormonal and Thyroid Health
For women struggling with unexplained Hashimoto’s flares, weight gain, brain fog, and worsening symptoms in their 30s, 40s, and beyond, this episode is a powerful reminder that hormone balance is a crucial missing piece of the puzzle.
Instead of only focusing on thyroid medication, women with Hashimoto’s should also evaluate their estrogen and progesterone levels, reduce exposure to endocrine disruptors, and consider supportive hormone therapy when necessary.
By understanding the interplay between estrogen, immunity, and thyroid function, women can take a more holistic approach to managing Hashimoto’s and feeling their best.
Eliminating Health Mysteries
With Dr. Gersh’s help, we were able to shed so much light on the many mysteries around Hashimoto’s, autoimmune and hormones. Could this be the missing clue for you or someone in your life? Please share this episode with them.
Links:
Resources mentioned
Thanks to my guest Dr. Felice Gersh. You can connect with her through her website where you will also find links to her latest books. You can also connect with her on Instagram and YouTube.
Related Podcast Episodes:
Weight Gain and Irregular Periods: The PCOS Connection with Dr. Erin Kinney Perimenopause and Hashimoto’s + My Personal Hormone Journey A Novel Approach to Supporting Hormones in Perimenopause and Menopause with with Emily Sadri A Novel Approach to Supporting Hormones in Perimenopause and Menopause with Emily Sadri (Part 2)Thanks for Listening
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