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[Anna69]

OK, so I have been having really, really bad night sweats recently. Some during the day as well, but the nights are a nightmare...waking up 8-10 times a night, soaked in sweat, having to change my sheets every day...I saw my OB-GYN the other day. An ultrasound revealed my "ovaries are completely atrophied which means I'm menopausal". I just turned 51.
I recently switched to Lenzetto from Estrogel (Besins Healthcare) but still have a few bottles of the latter left.
As far as I know, two pumps of Lenzetto (1.53 mg x 2) equal +/- three pumps of Estrogel 0.01% (each pump delivering 75 mg of E).
The maximum dose of Lenzetto is three pumps a day according to the PIL.
But I figured: if I use two pumps of Lenzetto + one pump of Estrogel daily, should that not be close to or the equal of four pumps of Estrogel (which is the maximum dose of that drug)...or three pumps of Lenzetto?
First of all, I'd like to use the Estrogel bottles as they expire 01/21, but I also think it makes sense to combine the two if needed.
I just need to make sure I am taking more or less the maximum dose?
My OB-GYN does not seem very interested, but mostly dismisses my complaints by saying "Well, it's the menopause, you know..": But I see no reason to suffer needlessly. My OB-GYN is not the one who put me on HRT, BTW, but a functional doctor prescribing bio-identical hormones (incl natural desiccated thyroid for my thyroid condition). Most conventional doctors where I live tend to prescribe oral estrogen + synthetic progesterone for menopausal complaints, and I really prefer bio-identical transdermal E + P (Utrogestan 100 mg every day at bedtime).
I have read that things can get pretty rough for a couple or so years after your last period, but then things usually settle down...I hope that's true However, I have read about women in their late 60s still suffering terribly...

[Wrensong]

Anna, reading your post quickly I note you are on thyroid replacement.  Can I suggest you get an up to date TFT done if you haven't had one recently?  I am also on thyroid replacement (T4 + T3) and have found I cannot tolerate Utrogestan under any circumstances, one of its truly horrible effects being much increased overheating at night & consequent worsened insomnia.  Following link to a study that found progesterone messes with thyroid levels.  I note too your "completely atrophied ovaries" - I have had BSO, so my lack of ovarian function is undisputed!  Wondering whether you may need to decrease your NDT or consider another form of progesterone.  I am in late 50s & with the complication of hypothyroidism find 15 years on from first menopause symptoms I still need full HRT.  That's not intended to be a downer, but to gently suggest it may be worth your while persevering to get a better HRT fit, in case, like me you are in it for the long run.  I hope you get it sorted.

https://pubmed.ncbi.nlm.nih.gov/23252963/

[Anna69]

Wrensong,

Thank you so much, that is VERY helpful info indeed!
I am not sure what TFT means, but here are my latest lab results (from January 2020):

FSH 18.0  UI/L (menopause 27-133)
LH 13.0 UI/L (menopause 5.2-62)
estradiol 37 pg/mL (menopause <28)
progesterone 1.0 ng/mL (menopause <0.2)
TSH <0.01 (0.4-4.5)
FT4 0.7 (0.7-1.5)
FT3 2.7 (1.7-3.7)

This was on Estrogel, Utrogestan, and 3 grains (180 mg) of Armour Thyroid daily.

My doctor insists that I take progesterone along with estrogen as I have not had a hysterectomy.

I have raised the possibility of switching to Tibolone, but that would require me to wait for at least one year since my last bleeding. Although infrequent and erratic, I still had periods until +/- six months ago.

Very interesting article about progesterone and how it affects thyroid hormone...I have read that micronized bio-identical progesterone will make you sleep better, but I find the opposite to be true...although I never made the connection between taking Utrogestan and feeling overheated.

Could you or anyone else here recommend a different form of progesterone, as I imagine I will need to take P along with E...? I know there are several forms of HRT, incl oral estrogen and progestins. My doctor favours bio-identical hormones, but I would be willing to try anything at this point. Or is there some other form of progesterone that could be added to Estrogel/Lenzetto?

If anyone has any experience with this, I'd love to hear about it!

[Wrensong]

Hi again Anna, my pleasure  .

I take it you are not in UK?  TFT here is abbreviation for Thyroid Function Test.  Looking at your thyroid ref ranges, with the exception of TSH they are quite different to those in UK, but one thing that stands out is that your TSH is suppressed indicating perhaps overtreatment (too much thyroid replacement) which could explain why you are too hot.  Though your FT4 & FT3 look fine according to the ref ranges you've given.

I have taken Armour in the past & could not get along with it,  but from what I remember 3 grains is a high dose.  Have you tried reducing the NDT a little to see whether you feel better?  Can I ask do you take all your Armour in one go or spaced throughout the day?  If you are taking any at night the T3 in it will likely exacerbate any overheating tendency, but you will know better than me what works best for you in terms of maintaining overall thyroid stability on Armour, so please don't adjust on basis of anything I say unless you are used to managing your own meds with the blessing of your doctor.  I have never been able to take any T3 later than early afternoon because it does make me too hot in bed & currently take only a very small dose & that 1st thing in the morning.

Your doctor is right to say you need progesterone to protect your womb, but it is unfortunately also the component of HRT regimens many of us struggle with.

Yes, many women report finding Utrogestan sedative, but like you I find it is the very worst thing for insomnia, with terrible overheating at night.  I have the impression it is far too powerful to combine easily with thyroid replacement & gives symptoms indistinguishable from those of over-treatment with thyroid hormone.  Convinced progesterone was potentiating my thyroid replacement, a few years ago I went searching & turned up a few articles that seemed to confirm this.  Unfortunately I never bookmarked them & last time I looked, was only able to turn up the one I just posted for you.  Perhaps progesterone is especially problematical for those like you & I who need the very powerful T3 as a component to our thyroid regimen.

I have tried the following forms of progesterone over the years: Levonorgestrel, Norethisterone, Dydrogesterone, Utrogestan, MPA (Provera).  All are synthetic (known as progestogens/progestins), apart from the body-identical Utrogestan.  The Norethisterone was the best in terms of tolerability, but was a component of a combined patch - Evorel Conti - from which I only got poor absorption of oestradiol, not enough for good symptom control nor to safeguard against progression of osteopenia.  I am currently using a very low dose of MPA which is also not without problems for me as regards worsening sleep.  MPA is a progestogen tablet, considered old fashioned & its use is somewhat discouraged because of doubts about its risk profile.  However, it was my only remaining option & I really need HRT.  It has the advantage of being available in a range of dosages & can be combined with an oestradiol patch, gel or Lenzetto which I have personally never used. 

I prefer oestradiol patches to gel for even release, resulting in fewer fluctuations, which seems to be essential for better symptom control in my case.  I am currently using Estradot patches at low dose & get better absorption from them than other patch types I've tried, as I think do many women posting here.

An alternative to Utrogestan/MPA is to have a progestogen-releasing IUD fitted (such as Mirena) if available where you are.  But personally I would not want a device I could not control myself given the extreme side effects I've had from progesterone.

I think as next step I would talk to whoever oversees your thyroid about maybe reducing the Armour a little?  That may be all you need to do for a better night's sleep & you will certainly not want to be on too much thyroid replacement long term.  If that doesn't feel the right approach to you, then maybe discuss changing the Utrogestan?

Wx

[Anna69]

I think the problem is that when you take anything containing T3 (be it synthetic T3 or NDT), it will suppress your TSH...which is why you need to go by symptoms, body temp, and free Ts (the actual thyroid hormones which should be in the upper quarter of range but not above range).
I have experimented with NDT for years and do not notice any benefits from multi dosing it. So I take it in one go in the morning, one hour before breakfast. That's just so much more convenient.
One grain of NDT = 38 mcg of T4 and 9 mcg of T3. T3 is ca 4 times more potent than T4 so 9 x 4 =36 (+38). Meaning one grain of NDT equals more or less 75 mcg of T4. So 3 grains would equal +/- 210 mcg of T4. I was on 200 mcg of levothyroxine before switching to NDT at age 42. But of course, as we age, we might need less thyroid hormone. However, since my FT4 levels are already at the bottom of range, I think i'd need to add some T4 to a lower dose of NDT. NDT contains slightly more T3 and less T4 than human thyroids so this would make sense...
You?re right, I'm not in the UK, I'm in the Netherlands.
I have been considering oral estrogen + progestin...there are so many options - Elleste Duet, Femoston...but my doctor says that oral estrogen should be avoided at all cost as it can cause breast cancer and heart disease/trombosis. She says transdermal estrogen does not carry any risks...of course, combining transdermal estrogen with progestin could be an option, provided i find a doctor who'd prescribe it for me...
However, from my research, it seems that oral estrogen can be more effective, and many take it, so I am not sure how bad it really is for you...?! From my own experience so far, I cannot say that using transdermal estrogen has been uncomplicated...
It never seems to get any easier...!

[Wrensong]

My TSH is not suppressed on T3!  But I only take a low dose. 

Thank you for the breakdown of Armour equivalency.  I have a PIL for it but had forgotten how it compared.  I feel overtreated on combination thyroid replacement with either FT3 or FT4 in upper part of ref range, but did need my FT4 quite high before menopause & my TSH nearly suppressed, but that was on T4 alone which was not satisfactory as I can't convert it well so need to take T3 on top.

Like you, I take my thyroid meds at least an hour before breakfast.

I get your point about your T4 being at bottom ref range - but the amount of T3 in 3 grains of Armour is a lot & it is very powerful so should surely be compensating for that?  If your TSH is suppressed & you have a classic symptom of overtreatment - feeling too hot day & night, I would wonder whether your Armour dose could be a bit too much.  But of course overheating is also classic for menopause, which makes working out what on earth's going on doubly tricky for us!  Can I ask do you have any other symptoms of over-replacement?

Something to bear in mind if you are considering going to oral oestrogen is that that form increases Thyroid Binding Globulin, effectively reducing available thyroid hormone, so women tend to need their thyroid replacement increased after starting oral HRT.  But it should be possible to find the right combination nevertheless.  That said, I see no reason for you to change from transdermal oestrogen, which as you say has a better risk profile.. That is, if you can get alternatives to Utrogestan if you feel that's the problem & not your thyroid replacement. 

Sorry, can't remember whether you said you'd tried oestradiol patches?  I think we hypothyroid ladies need as much stability as possible in terms of adding exogenous sex hormones to the mix & in my experience the patches tend to produce less of a peak & trough effect than other methods.  You are right though, combining HRT with thyroid replacement is not as straightforward as we might wish!

[Wrensong]

Anna, if you really don't think your Armour dose is too high, another approach occurs to me: if you are currently taking Utrogestan on a continuous basis that makes it harder to gauge whether it is progesterone at the root of your probs.  If you have not tried a sequential regimen, doing that & seeing how you are on the oestrogen only phase might help you work out what's going on.  Drawback is that you would then have a monthly withdrawal bleed & the standard dose for Utrogestan on a sequential basis is double what you are currently taking, so if progesterone is your problem you would likely feel even worse during the prog phase of the cycle.  I also feel sequential regimens are a bit harder to combine with thyroid replacement - the lack of consistency seems to upset the apple cart, given homoeostasis is already compromised in thyroid disease.

[Anna69]

No, I don't have any specific symptoms of thyroid overmedication. Like you say, the sweating and hot flushes could be caused by menopause and also appeared when I had been on 3 gr of Armour for years.
I briefly tried estrogen patches, but they did not stick. I ended up replacing the patches several times a week so that was not really a cost-effective solution in the long run.
A friend of mine takes tibolone (Livial) and says it's great. She has not had any hot flushes or other symptoms since going on it. I've read about it, and I like the idea it has androgenic properties as my testosterone levels are very low, and that too can cause symptoms. But I've also read that tibolone is not as effective as HRT when it comes to relieving hot flushes (which I'd say are my most bothersome symptom right now), so maybe tibolone is a better choice for someone with less severe symptoms?

[Anna69]

Wrensong,
I just saw your latest post about prog.
I used to take it cyclically (200 mg 12 days a month) until recently, when the doctor suggested I try taking it continually instead. I did NOT have the symptoms back then that I have now, but at some point menopausal symptoms tend to peak, right, and maybe I am at that point now...or prog is the problem. After all, switching from taking it cyclically to continuously coincided with the onset of my current symptoms. Interesting thought, thanks!
Anyway, I don't see any reason to take it continuously if It does not make me feel better. After all, your prog levels only peak for two weeks a month...so it might be worth going back to taking it 12 days month, and see if it makes a difference.
The reason the doctor suggested taking it every day was because my last periods were really heavy and lasted for almost two weeks. The doctor said that taking prog daily would not result in withdrawal bleeding.

[Wrensong]

I see your reasoning about having been on 3 grains of Armour for years, but sometimes we do need less thyroid replacement as we get older.  That's certainly happened with me, so I wouldn't rule it out.  But if you have no other symptoms suggestive of overtreatment that's good!

I have no experience of Tibolone.  Maybe you could start a new thread asking about that?

I take a little testosterone as part of my HRT regimen & if yours is low I would recommend it.  In addition to the other effects it's well known for, that may also help with your sleep.  I've only been taking it a few months, my sleep has definitely improved (though my oestrogen dose went up shortly after starting T) & there are articles about T's importance for sleep if you google.  The menopause gynae who first prescribed T for me years ago told me it should help with night sweats too.

Looking back at your oestradiol blood result & converting the pg/mL to pmol/L, yours still seems quite low according to the ref range.  When you say transdermal oestrogen has not been without probs do you mean your absorption has not been too good?  What does whoever you see about menopause say about that level - do they think it should be adequate for symptom control?

If you were better on a cycle then that could be worth going back to if you don't mind the bleeds.  If symptoms improve again you'll know it was likely taking progesterone continuously that didn't suit you.  But as you also say, symptoms change throughout the transition so there's less certainty until you're more stable postmenopause when your own hormones are more consistently low.

Later edit: Anna, sorry - I have just seen there is a previous page to your thread I hadn't noticed when I first posted the other day.  Wrt the hirsuitism - I'm not sure about the wisdom of adding Testosterone now I know that's been a prob for you.  Sorry I didn't notice the previous page & so asked you questions you'd already answered!

[Anna69]

Wrensong,

Absolutely no problem and thank you so much for replying!
The doctor who prescribes HRT is the same who put me on NDT. it's  so called anti-aging doctor working outside the system (you have to pay for everything yourself - doctor's fees, labs, even many drugs are not covered by health insurance). I only see her once a year since she has a very long waiting list. Last time, I asked about my lowish E levels....it seems she is too stressed to notice as she seems to take on more patients than she can handle. She then said I could go from two to three sprays of Lenzetto daily. In the past, when on Estrogel, I have used four pumps daily (each pump = 0,75 mg of E).
My T levels have never been out of range or anywhere near the upper range...however, my cortisol levels are slightly elevated as confirmed by recent saliva test, and I have read that can also lead to hirsutism.
I do find sex hormones quite tricky to use, as too little and too much can really wreak havoc on your whole system...I have found it very hard to find a dose of E and P that works but does not lead to symtoms of being either under- or overmedicated. I have never used oral estrogen so cannot compare how that works to how transdermal estrogen works...but, then again, my recent symptoms may not be related to estrogen, but rather to progesterone...I never really suspected Utrogestan could be the problem as it's often said that you need progesterone as you age and that it will counter all the negative effects of estrogen...sometimes, it feels like P is described as a panacea with no ill effects whatsoever, whereas E is often described as the villain...

[Wrensong]

I feel for you Anna - the complication of a thyroid condition on top of a difficult menopause, especially in cases where thyroid replacement has to include T3, can make for a particularly difficult time, I think. 

Like you, I pay for a lot of my healthcare (no insurance) as the NHS is iffy about T3 to say the least, so consultant fees, bloods, investigations, some medications & even recent surgery.  It all adds up & in our case comes out of one modest income.  But I do feel really lucky we can afford to pay for some of what the NHS can't do for me & we forego other things in order to do that.

I'm so sorry your doctor didn't give a satisfactory response to your query over the lowish E, that doesn't help your situation does it?  Could you maybe ask around to find out whether there's a more attentive doctor you could see instead?  It seems as though you are largely managing on your own in difficult circumstances & I don't think you should be.

it's often said that you need progesterone as you age and that it will counter all the negative effects of estrogen ... sometimes, it feels like P is described as a panacea with no ill effects whatsoever, whereas E is often described as the villain...

I agree about it being tricky finding the right balance of sex hormones & too much of any sort of replacement is definitely not a good thing, but I thought it was more generally believed that it's the progesterone component of HRT regimens that's the source of both unwanted side effects & greatest risks.  Though in perimenopause when I went many months between periods I came to recognise the unpleasant symptoms that came with oestrogen dominance, so wouldn't dispute that state can be problematic.

My understanding is that there is increased production of cortisol in hyperthyroidism (so presumably same applies to overtreatment with thyroid hormones), which makes me wonder again whether the large amount of T3 in your 3 grains of Armour could be rendering you overtreated, causing some of your symptoms.  As you say, the ratio of T4:T3 in NDT is not identical to that in the human body, with T3 being over-represented in Armour - one reason many doctors disapprove of its use.  But neither your T3 nor T4 were high when last tested which is incongruous with a suppressed TSH & if you don't feel overmedicated I find it hard to get a grip on what's going on.  Can I ask when your thyroid bloods were taken, how many hours was it since you had your dose of Armour?  You will know that T3 has a very short half life so that if bloods are analysed 8 hours or more after a dose of T3 or medication containing it such as NDT, the T3 level will have declined & depending on how long since last dose, can be negligible.  My thyroid bloods are always done before that day's dose of meds in accordance with my Endo's instructions & the T3 then shows below bottom of ref range.  I'm wondering whether it's possible for your T3 to have been too high for part of each day accounting for the suppressed TSH, but showing mid-range on testing because it was maybe some hours since you had your dose? 

Another thought is that if you were on too much thyroid replacement, the resulting increased metabolic rate I think could cause over-fast clearance of your HRT, making it difficult for you to build up your oestrogen - perhaps accounting for that still being rather low.

Sorry to be like a dog with a bone over the issue of the suppressed TSH, but I'd hate for your long term health to suffer if there is any chance you are unwittingly on too high a dose of Armour.  Just want to help you get to the bottom of what's going on so you can feel well again & get on with your life.

[Anna69]

I know, and I'm grateful for your input and suggestions!
I take Armour once daily (in the am) and have labs 24 h later (before taking Armour), so my FT3 levels were more or less 25% higher on the previous day...so at top range or possibly slightly above (which would point to being slightly overmedicated).
A few years ago, I was on 5 gr of Armour daily, and no way near optimally dosed. However, back then, I had a lot of mineral and vitamin deficiencies that I have since worked on correcting (vitB12, vit D, iron, ferritin, magnesium, zinc). They all play a role in T4 to T3 conversion, so it's possible that once I got them optimal I ended up needing less T3.
I know that NDT contains more T3 and less T4 than produced by a healthy human thyroid gland, and have been thinking about decreasing NDT and adding some T4 to get a better ratio. A little can go a long way, especially where T3 is concerned, since it's such a powerful hormone.
I am not too happy about the way my doctor deals with patients; only seeing them once every 12-18 months because she's overbooked, the appointment only lasts one hour which isn't much with so much to go through (three pages of lab results...). So, it's more or less about renewing my prescriptions and telling me to get in touch if I have any questions. Re my latest labs, I was surprised to see the low E and T levels, but the doctor seemed to dismiss them, just renewing my prescription for estradiol and telling me T could make hirsutism worse...when in fact my T levels have always been on the low side, so most likely not responsible for my increased hirsutism (I think cortisol is the culprit).
Also, after going off the short-term steroids, I ended up with slightly out of range fasting blood sugar levels (110; ref 70-105, should ideally be <80), and my previously highish insulin went from 13 to 18 (2.4-24.9; ideally they should be <5). I am sure this explains my weight gain since weaning off the steroids (+20 kg in no time), but the doctor said my insulin levels looked "good" and that there is currently no reason to treat this with drugs. However, this is insulin resistance, and leaving it untreated can lead to diabetes 2.
I think the best thing I can do as things stand is to find a supplement that lowers blood sugar levels and increases insulin sensitivity. There is one that has got great reviews, Diabecon (also available as a double strength version), but it contains licorice root and I am on blood pressure medication so don't think that would be a good idea. I would prefer not to use prescription drugs as they all seem to have pretty unpleasant side effects. I have not given up hope my condition is reversible.
I have seen a couple of conventional gynaecologists for menopause counselling but one would only prescribe oral estrogen (no P although I still have my womb), and the other would only prescribe oral E and progestin. OK, maybe progestin is not the problem I once thought it was, but I am still not sure about oral E...as you say, it will decrease thyroid hormone levels, it stimulates breast tissue and increases the risk of blood clots. Since I'm overweight, I am not sure this would be the best thing to try right now. And, bio-identical E and P have not been that great either when it comes to symptom-relief (and that is all my functional doctor will consider).
I like the fact that tibolone does not contain actual hormones, but a substance that the body uses to make hormones - E, P, and T. I have found quite a few posts here about it, but of course as with every drug, some say it's great and some say it didn't work for them.
I recently read a book called "Tired thyroid". The author is on NDT + T4 herself, and she says something that I haven't not read elsewhere: that excessive levels of T3 can cause or worsen insulin resistance. That is interesting given my problems with high insulin and blood sugar along with weight gain. it's possible that getting too much T3 from the Armour could have made this condition worse...so I think I should decrease Armour and add some T4. Maybe some of my symptoms would clear up with lower levels of T3 and slightly higher levels of T4. it's also entirely possible that my recent night sweats have been caused by too much T3 and not low E and P levels...or possibly a combination of both.

[Anna69]

PS.The doctor suggested I add 20 mg of DHEA daily to try to raise my T levels. However, I have read that DHEA won't just convert to sex hormones as needed, but can be converted to any sex hormone, making hormonal imbalances worse...so, if P is really my problem, and the DHEA converts mostly to P (instead of T), that will make the problems worse. I took DHEA for about two months, developed very greasy skin (like being a teenager again) so went off it with no ill effects. But, looking back, the onset of my current symptoms coincided with the addition of DHEA. I don't know if it can cause long-term side effects even after going off it...

[Wrensong]

Thanks for the info on your Amour & testing timings, Anna.  OK, so your bloods are done 24 hours since last dose of Armour, same situation as my testing.  Where did you get the "25% higher previous day" figure for your T3?  I'm not familiar with that calculation.  If your T3 was still mid-range 24 hrs after taking any, I wonder whether that points to your either being able to produce a significant amount of T3 for yourself or there being proportionately too much for you in your current Armour dose, as I think we are both coming to suspect.  As mentioned earlier, 24 hrs after my dose of T3 (tiny by comparison with yours btw, but as much as I feel I need), my bloods show T3 to be below bottom of ref range, due to its short half life.  The amount of T3 & T4 I take are more or less in physiological proportion to that produced by someone with a healthy, intact thyroid.  Not by calculation - I just found in recent years that that ratio of replacement T4:T3 works best for me.  My endocrine meds are not perfect by any means, given T3's short half life & the fact my HRT is still a work in progress, but I think the thyroid replacement we've fine-tuned is about as good as it gets for me.

Yes, various minerals & vitamins are involved in T4->T3 conversion which is why I always urge caution when any members with a thyroid condition talk about supplementing.

Can I ask have you always been on NDT or did you swap after finding synthetic thyroid hormones inadequate?  I'm interested as I tried Armour too, in desperation about 15 years ago but couldn't make it work for me. 

Don't worry, I know from your previous comments you are knowledgeable about the makeup of Armour & the powerful nature of T3.  I also respect your individual experience & feel that no-one knows our own bodies better than us.  But over the 25+ years since thyroidectomy I've also found it frustrating that however well meaning, most doctors have little training in thyroid disorders, which puts the onus on us to learn as much as we can, be our own detectives & advocates.  I think this is where exchanging experiences can sometimes help throw a little light on what's going on.

I am not too happy about the way my doctor deals with patients; only seeing them once every 12-18 months because she's overbooked, the appointment only lasts one hour which isn't much with so much to go through (three pages of lab results...). So, it's more or less about renewing my prescriptions and telling me to get in touch if I have any questions.

I have to say I wouldn't be happy with that either.  I see my Endo roughly every 3 months with email contact between & instructions to get in touch at any time I need to.  He is as experienced & senior as it gets & very well respected.  Oversees all my endocrine care including HRT.  I think it's invaluable having an expert take a holistic view in our situation.  I feel fully involved in decisions too - he listens, is very kind & not heavy handed, so worth his weight in gold to me.

I think the best thing I can do as things stand is to find a supplement that lowers blood sugar levels and increases insulin sensitivity.

Ooh Anna, do please be careful.  Your blood sugar issues are different to mine (mine often low - confirmed by bloods - which can be a pain too), but I agree important to try to normalise the situation, though I would be wary of supplementing without supervision.  Especially given your homoeostasis is already compromised by being menopausal with a chronic thyroid disorder. 

I have no experience of steroids/DHEA, so can't help there I'm afraid.

Surprised to hear the gynaes you saw would only prescribe oral oestrogen when as we know transdermal is generally considered the safest method.  And that one wanted to prescribe oestrogen without progesterone for a woman with intact uterus is pretty shocking.

It's not just oral E that stimulates breast tissue btw.  All forms of E, P & T have effects on the breasts.  Utrogestan is currently considered the safest form of progesterone in terms of risk, but that doesn't mean it has no effect on breast tissue.

?I think I should decrease Armour and add some T4. Maybe some of my symptoms would clear up with lower levels of T3 and slightly higher levels of T4. it's also entirely possible that my recent night sweats have been caused by too much T3 and not low E and P levels...or possibly a combination of both.?

I don't know for sure Anna, but I think you could be onto something with the level of short-acting T3 in Armour being possibly more than you currently need & the background T4 maybe being insufficient.

It worries me that you feel you have to manage all this largely on your own, given the doctor overseeing your care is only available for one inadequate consultation a year.  I think in your situation I would ask around & try to get to see a recommended Endocrinologist who will listen & has the time to work with you.

I have not given up hope my condition is reversible.

No, please don't lose hope - it should be manageable with the right sort of sympathetic & open-minded expert help.  Just that menopause is a time when everything can feel beyond control.  But that will improve the further you go through, in as much as flatlining sex hormones mean a more stable base to work on.

My heart goes out to you & I really hope you manage to get the specialist help you need to get to the bottom of it & feel really well.  Do keep posting if there's any way any of us might be able to help & to let us know how you get on. 
Wx