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[Gilla999]

I started on Lenzetto / cyclical Utrogestan in April after suffering from debilitating night sweats and insomnia for two weeks out of every four, for about a year. I am however still ovulating and having regular periods. The Lenzetto has been an absolute dream and pretty much got rid of all my symptoms. I had tried two contraceptive Pills (back to back, no breaks taken) prior to starting Lenzetto which didn't work and actually made me more symptomatic, so to find something that has worked for me has literally been life changing.

However the massive problem for me still is that I gained a large amount of weight in a very short space of time - in total it was 1.5 stone over about 4 weeks, and was gaining about 5-6 pounds a day some points during that time. There was absolutely no change in my eating or exercising and it to me felt like a reaction to something, to gain such an amount of weight in a short space of time. This actually happened just prior to starting HRT in Feb/March, when I was still trying to take the Pill. At the same time I started suffering with chronic constipation - it is really very bad, and nothing I eat or pills I take (prescription or otherwise) make any difference. Doctors don't know what's wrong so have dismissed me.

I have always felt that perhaps this was because my circulating estrogen was too high, firstly with taking the Pill with no breaks and then moving onto two sprays of Lenzetto (I have read high circulating estrogen can cause both weight gain and constipation) so twice I tried lowering the Lenzetto even slightly but failed due to reoccurence of problems. So if it appears that 2 sprays are actually the amount of estrogen I need to be symptom free, I don't understand what could have caused the rapid weight gain and constipation. I had some thryoid tests done that show I am borderline hypothyroid - I'm on the last number of normal before it falls into hypo range - and I have very high antibodies present. I don't know much about thyroid issues but I wondered if anyone here had experience as to whether that could be responsible for the weight gain and chronic constipation, even though it is (only just) still in the normal range? I also wondered if changes to your estrogen levels can cause thyroid issues...?

I'm really confused and no doctors are interested - it's so frustrating as the weight and constipation are the ONLY things stopping me from feeling like I can be back to my old self and I would really like to understand what is causing it!

[Wrensong]

Hi Gilla, sorry to know you are having problems with weight gain & constipation on HRT.  I'm long term hypothyroid on thyroid replacement & HRT and thyroid conditions can certainly muddy the picture at menopause.

I had some thryoid tests done that show I am borderline hypothyroid - I'm on the last number of normal before it falls into hypo range - and I have very high antibodies present.

I suggest you talk to your GP about having a repeat thyroid function test at an interval he/she thinks appropriate, so that if you are becoming hypothyroid this is picked up sooner rather than later & you can be started on some thyroid replacement.  With high antibodies, borderline hypothyroid test results & some symptoms suggestive of underactivity, it does seem possible your thyroid is failing, but only repeat testing will show whether this is the case.
It is possible to have thyroid antibodies without developing thyroid failure & it would be inappropriate to start a patient on lifelong medication if it's not necessary.

I don't know much about thyroid issues but I wondered if anyone here had experience as to whether that could be responsible for the weight gain and chronic constipation, even though it is (only just) still in the normal range?

Weight gain & chronic constipation can be consequences of an underactive thyroid but I'm not sure whether this would explain weight gain to the degree you've experienced in such a short period with a TFT still within range.  Sorry, that's not much help, I know.

I also wondered if changes to your estrogen levels can cause thyroid issues...?

  Women on replacement thyroid hormones can find their dose needs adjusting to balance with their HRT. 

Oestrogen is said to boost immunity & there is debate over the use/effects of HRT in some autoimmune diseases (e.g. Lupus, Sjogren's) but as with all things endocrine the association is complex & I think not that well understood.  I haven't seen any research suggesting HRT might be involved in causation of autoimmune hypothyroidism if that's what you're asking, but I do wonder what as yet unidentified effects it might have on those of us with autoimmune tendencies.  We can only take what meds are available to treat our symptoms & try to be attuned to what our bodies are telling us, though at menopause with so much changing that can be quite a task!
Wx

[Gilla999]

Thank you Wrensong, this is so knowledgeable and helpful! Yes, I had wondered if I had somehow tipped myself into having hypo by increasing my hormones, so interesting to know there is no link there. And you're the second person who has said rapid / sudden and large weight gain would be unlikely to related to thyroid. I spoke to an Endocronologist and he offered to start me on 25mg thyroxine to see how I go but I'm obviously not really wanting to take something unless I have to.

I just don't understand what could account for such a rapid amount of weight gain and constipation - both the things came together. I can't even blame the HRT specifically because it happened before that, at the end of a 5 month trial period of back to back contraceptive Pills.

Has anyone else experienced a lot of sudden weight gain in relation to taking HRT or contraceptives? It just seems strange that I would experience it and yet clearly need that level of estrogen because if I don't I'm symptomatic with night sweats and insomnia    No amount of dieting or exercise makes any difference at all - it feels like something has happened to my metabolilsm that's made it ground to a halt. I'm not even feeling hunger in the same way as I used too - all so confusing!

[Wrensong]

Hi again,

I just don't understand what could account for such a rapid amount of weight gain and constipation - both the things came together. I can't even blame the HRT specifically because it happened before that, at the end of a 5 month trial period of back to back contraceptive Pills.

  BCP could have a similar effect to HRT in terms of potential for fluid retention contributing to weight gain & could also be implicated in constipation - all gynae hormones after all.

it feels like something has happened to my metabolilsm that's made it ground to a halt. I'm not even feeling hunger in the same way as I used too

   I do really notice the effect on slowing of metabolism when I need to increase my thyroid medication & being backed up does reduce appetite.

Can I ask do you have any other symptoms of low thyroid, such as feeling disproportionately cold for weather conditions, unusually poor stamina, loss of outer section of eyebrows?  Also are you finding you're passing less water than you used to?
Wx

[Gilla999]

Coldness not really - i tend to swing between too cold and then too hot! Stamina 100% yes but I had put that down to the weight gain. I've always had a problem with frequent urination but I have noticed that I'm struggling to go now - as in, i still have a frequent urge but it feels like I can't get it out and I'm not emptying my bladder properly (I'm not sure if that's what's you meant?).

If it isn't my thyroid and is in fact the hormones it just doesn't make sense to me that i would need this level to be non symptomatic and yet it would cause such strong side effects with it. The only other change is that my cortisol is consistently out of range / high throughout the day - that started at the same time as the weight gain and constipation and I've no idea what would have caused that or how to address it (I don't feel stressed or anxious at all!).

I really appreciate your thoughts on the thyroid thing as I'm not knowledgeable about that side of things at all!

[Wrensong]

The thermoregulation difficulty can also be a feature of hypothyroidism, but of course menopause too.  I really struggle in both cold & heat.  Takes an age for me to warm up & cool down, but then my thyroid replacement is a bit clunky as I need 2 types of thyroid hormone, but that's unusual & most people do really well on thyroxine alone.

With urination, I meant do you notice you're passing lower volumes than you used to - any indication your kidneys are a bit sluggish as that could also result from an underactive thyroid.  But difficulty emptying as you describe could be partly mechanical too, tied up with the constipation.  And hindered by pelvic floor dysfunction.

High cortisol can result from an underactive thyroid.  So constipation, weight gain, high cortisol, poor stamina, possible fluid retention, poor thermoregulation, thyroid function close to bottom ref range & high thyroid antibodies.  Beginning to add up a bit.  I take it you meant your T4 was low?  Was TSH towards top of ref range?

I spoke to an Endocronologist and he offered to start me on 25mg thyroxine to see how I go but I'm obviously not really wanting to take something unless I have to.

If an Endocrinologist who's seen your results has suggested a trial of 25mcg thyroxine he must think it a reasonable course of action & as you're so uncomfortable, with some of the classic symptoms of hypothyroidism, I would give his suggestion some serious thought.  Are you able to speak to him again without a formal appointment?  Wondered whether maybe he's a colleague or friend.  Perhaps more insight into his thinking would be reassuring & help you decide?  He should be better placed to advise than your GP, so I'd make the most of the opportunity for expert opinion.

[Gilla999]

Yes sorry T4 was low:
T4 = 12 (range 12-22)
TSH = 3.3 (range 0.27 - 4.2)
T3 = 4.4 (range 3.1- 6.8  )
Thyroid peroxidase antibodies = 96 (range 0-34)

Endo sort of "gave me the choice" (as I find docs seem to do these days... except when it comes to HRT of course  ) I got the prescription and tried it for two days but then I couldn't sleep, I felt really hyper, so I stopped it. Do you think two days is way too quick to have a response to thyroxine like that? My sleep is so sensitive it is the first thing to "go" so it could have been a number of other things instead but I chalked it up to the thyroxine and stopped it. However I've heard thyroxine takes time to build up in your system so not sure if it was likely to have been that? Perhaps I should give it another try.

You're right on the symptoms list - the only way I can describe it is it feels like something happened to my metabolism and the whole thing has ground to a halt, both with digestion, hunger, energy levels... it felt like something "switched" and I can't understand if this would be likely to be from excess hormones (but if that's the case why reducing would cause me to be symptomatic) or if it could be something else. Wrensong thank you so much for this, it has been extremely helpful! I'm going to give the 25mg another try and see how it goes    At least then I'll know!

[VictoryV]

Hi Gilla999,
I had the contraceptive pill in my mid 20’s for 3 months and gained two stones. I was on my feet all day and working long hours, my daughter was little and I was studying through the night; life was tough. Money was tight and I ate very little.
I don’t remember what the pill was called but I think it was Dianette(sp?). The weight dropped off as soon as I stopped taking it.
Victoria ☀️

[Wrensong]

Thanks for posting the TFT results, Gilla, that's very helpful . As you say T4 is right at bottom range but TSH & FT3 are OK, so it's quite difficult to interpret & to know what to do about the Endocrinologist giving you the choice of whether to start thyroxine, especially as the presence of TPO antibodies doesn't necessarily mean you will eventually become overtly hypothyroid.

I don't know whether your sleep could have been adversely affected by just 2 days of thyroxine at low dose.  You're right it takes time to exert full effects but if you are sensitive to medication & already struggle with sleep & your TSH & FT3 are OK so thyroid supplementation may not be what you need right now, then I wouldn't rule out that it could have been responsible. 

Can I ask what time of day you took the thyroxine?  And was it during the Utrogestan phase of your cycle?  Do you usually sleep OK on Utrogestan or does that make you feel a bit hyper?  I ask because it makes me feel very revved up & worsens my insomnia.  Sorry for so many questions, please don't feel obliged to answer anything you're not comfortable with.

Your sense of a much slowed metabolism certainly squares with an underactive thyroid, but in spite of the low T4 your TSH & FT3 are OK, so like you I'm really not sure we can assume such sluggishness can be entirely attributed to what may or may not be going on with your thyroid.  That said, I do find even transdermal oestrogen increases my requirement for thyroid replacement so maybe if your thyroid is under par you are feeling additional effects from the oestradiol in your HRT, but don't quote me on that, I'm just thinking out loud & trying to make sense of the way you feel.

Crumbs Gilla, what a pity the Endocrinologist didn't lean one way or the other, but I expect he's just as unsure.  I don't know what to say & don't want to sway your decision.  I think as you suggest, if you want to try the thyroxine again, maybe start during the oestrogen only phase of your cycle.  Ruling out any potential influence from Utrogestan might help you gauge whether it was the thyroxine responsible for the hyper feelings & sleep disturbance.
Wx

P.S. was writing this while you were posting, Victoria.  What you say is very interesting in light of Gilla's situation.

[Gilla999]

I don't mind the questions at all, I'm grateful to have someone to mull it over with as it's such a strange one. I know that something has caused it, I just have absolutely no idea what. I've been on the contraceptive pill (many of them, including Dianette) and never gained 1.5 stone from them and had this terrible constipation (and of course now I'm on HRT and not the Pill) so I'm not really sure how that could be to blame - especially as I have tried to lower my Lenzetto to see if things improve and then I start being symptomatic again.

I took the thyroxine first thing in the morning - I always do that with meds so they hopefully have as little impact on my sleep as possible. Yes it was during the Utrogestan part of my cycle. Utrogestan 100mg vaginally I cope completely fine with with no side effects but when I have tried either to increase to 200mg vaginally or when I lowered my Lenzetto during the Utro phase, both times I felt the Utro much more strongly and wasn't able to hack it - but it was only that I was extremely drowsy during the daytime. I haven't experienced Utro either helping me sleep at night or causing me insomnia though.

I completely understand not wanting to sway someone's decision, I'm also always reluctant to advise people as you can only go by your own experiences!

One other thing I noticed happen at the same time was that my testosterone level has halved from what it used to be - I always had testosterone at the top end of the range, although never had any high testosterone symptoms - I think it was just my natural state. But when I last had it tested in April it was half of what it used to be. I'm not sure if this could have been a result of the contraceptive Pills or HRT or whether it can affect weight etc.

So many different things going on...  high cortisol, lowered testosterone, borderline low T4 and yet none of it pieces together to make any sense! The Lenzetto has been such a life saver for me it's just so upsetting having to still deal with these other symptoms and no idea how to fix them 

[Wrensong]

Ah, the 2 days of thyroxine were during the Utrogestan phase of your cycle.  Reason for asking was, as mentioned earlier, Utrogestan makes me feel horribly hyper  .  I've had 4 trials of it with different doses of oestrogen, but have been unable to tolerate it each time.  It feels to me as though it makes me markedly over-treated (with thyroid replacement).  When I researched to see whether this could be the case, I came across a study that found progesterone increases free T4 levels.  Small study & the effect was fairly modest, but it seems to confirm my sense that the worst of the side effects I get from Utrogestan are due to it potentiating my thyroid replacement intolerably.  So I do wonder whether the same happened with you - that the Utrogestan was effectively magnifying the effects of the modest dose of thyroxine on top of what you're still making for yourself & that's perhaps what made you feel hyper.  I should stress I'm basing this purely on personal experience & one small study.

I completely understand not wanting to sway someone's decision, I'm also always reluctant to advise people as you can only go by your own experiences!

Yes exactly - all we can do here is share personal experience/compare notes.

One other thing I noticed happen at the same time was that my testosterone level has halved from what it used to be . . . I'm not sure if this could have been a result of the contraceptive Pills or HRT or whether it can affect weight etc.

There is mention in the medical literature that hypothyroid women may be low in testosterone & that can be associated with weight gain & decreased energy.

Chronic constipation is a truly horrible thing to deal with & as you've tried everything in terms of diet etc, that must make you feel powerless.  It's a symptom many hypothyroid patients really struggle with.  All I can say is I follow a very high fibre GF diet including a weighed portion of prunes every day, drink lots of water & exercise daily.  But if it turns out you do need thyroxine it should help you manage that symptom more easily.

I do hope you find a way forward & I completely understand your frustration & dismay.  Always happy to chat about thyroid matters any time it might help & I'd be very interested to know how you get on with or without thyroxine.  Whatever you do, I would try to get another TFT & thyroid antibodies tested, say 6 weeks after starting thyroxine if you continue with it, or maybe 3 months after last test if you don't, unless your Endocrinologst has advised otherwise of course.  Do you have a follow-up appointment with him?
Wx

[Gilla999]

How interesting on the Prog / thyroid link. I totally understand you're basing this on your own experience and research - that's the kind of thing I'm always cautious to say to others here, as none of us are experts! But I find it really helpful to hear of others experiences, and I have learnt SO much through this forum that has helped me... I actually have no idea where I would be had I not discovered it!

My Endo said to come back in 3 months which would be next month (though he thinks I've been taking the 25mg). I should say he actually prescribed me 50mg and said that anything less was almost a homeopathic dose and we would only know if my thyroid really was responsible by taking a 50mg dose, but after reading online that most people start at 25mg that's all I would feel comfortable taking anyway - I'm so annoyingly sensitive to all medications. I've had a couple of rubbish days of not great sleep so once that's back to being in a good place I'll probably give the 25mg another go and see how I get on.

The ONLY other thing I can think is that while 2 sprays of Lenzetto is clearly the amount of Estrogen I need not to be symptomatic, whether I'm just not getting enough Prog into my system to counteract it (I take 100mg vaginally for 12 days a month). I wonder if it's not so much the strength of the estrogen that's the issue (backed up by a blood test I had which showed a normal level on Lenzetto) but the lack of Prog to balance it out in the 2nd half of the cycle. I know that not much is absorbed systemically from the vaginal route, but I find it impossible to take Utro orally - I'm a zombie the next day! Even increasing to 200mg vaginally made me feel too tired!

Wrensong thanks ever so much for all your thoughts and input, it's really helped me - much appreciated 

[Wrensong]

Glad the endocrinologist didn't discharge you.  Yes, patients are often started on only 25mcg (micrograms), so that seems reasonable if you are very sensitive to meds.  If he was expecting you to take 50mcg though, I would explain why you didn't  !

I hope you feel better for the thyroxine if you do decide to try it again.  Bear in mind it can take quite a while to feel the benefits though.

[Shannonplussed]

Your story sounds so much like mine. It feels like a long story but I’ll try to keep it as short as I can. (Rereading-I didn’t!)

I was in my late 30s and needed a Mirena to control post-coital bleeding. After about 3 years, I had some crazy roller coaster symptoms that in hindsight were peri menopause (but the drs said I was too young). I wanted off the roller coaster, so I went on the birth control pill, taken back to back (and for a few months, I still had the Mirena in place, until I was able to have it removed; the strings had gone inside). This seemed okay but I gained a tiny bit of weight and felt hungry often. I got engaged and decided to go on Weight Watchers (starting weight was 127 lbs; honestly they shouldn’t have let me join). WW absolutely messed up my relationship with food, causing restriction-binge cycles (because I just was not eating enough, and by the end of the week my body made up for it). I was getting chronic constipation, to the point that I saw a pelvic floor physiotherapist to see if she could help me (didn’t really get anything out of that).

Kept that up for a few months, then had enough. Went off the diet (at 122 lbs) and leaned into Intuitive Eating (which I recommend highly for anyone and everyone). In this, there is an understanding that you may gain weight (or lose it) while you reestablish hunger, fullness, and satisfaction cues. Just ride it out and let your body be, as difficult as it can be. So I did, and I ate lots of ice cream. Stopped forcing myself to exercise, and rested my body instead of punishing it/working out to “earn” food.

At this time, I was sick of decades of being in charge of birth control, so I convinced my partner to get a vasectomy, and I went off the pill. I got daily headaches for months and very rapid weight gain. Yes, I was being lazy and indulgent (for me), but this was otherworldly weight gain. Very very quick, and as you say, like a switch was flipped. I was hungry all the time (I attributed this to recovering from the diet restriction, but you know it was also the same feeling as that PMS craving, there’s not enough food feeling, primal hunger). Still constipated. I gained weight so quickly, I was alarmed and saw a dr. They found no issues with thyroid, but low ferritin, which was treated.

I kept thinking that once my period came, things would regulate; some weight would drop off. I read about how the pill can put your ovaries to sleep, so I tried to be patient. I wasn’t though. I pressed the dr, who once he saw my weight had climbed to 155 lbs in just a few months, ran all kinds of tests, a full thyroid panel, cortisol test, referral to endocrinologist, MRI. Nothing was ever out of range. But I looked and felt pregnant. People thought I WAS pregnant. I was always, always a waif, except when I was pregnant—I gained a lot of weight when pregnant, which I lost pretty easily.

Still no period. I saw another dr and asked for a course of Provera to reset/kick start my period. She said no, not until we run some tests. That’s when the early menopause diagnosis came, just before I turned 43. High FSH, repeated several times over several months.

I realized all the symptoms that I had that seemed like pregnancy or hypothyroid were menopause. I pressed for HRT, and started it eagerly. I continued to gain weight, up to 165lbs. So 127-165lbs in about 6 months. I was always tiny. I looked like a different person. I had to get all new clothes. I didn’t recognize myself.

I’ve been on HRT now for 2 years and things feel a lot better, but I think, in hindsight, a lot of symptoms were from too high estrogen. I have a Mirena again and use estrogel minimally (I have tried up to 4 pumps a day). I’m down to 142 lbs and feeling very well overall and happy with my relationship with food and exercise.

If I’m not mistaken, you were taking the pill back to back in an effort to overrride your own hormones, is that correct? I wonder if both of us really did put our ovaries to sleep, if that’s even a thing. I don’t have the answers, but I can relate so hard to having hypo symptoms but not testing as such. To getting some relief from HRT but feeling like metabolic rate has stopped dead.

I still wish I could flip the switch back, but after 3 years, this seems to be the new me.

[Scampidoodle]

That’s so interesting Shannon. What dose of E do you use now?

Do you still have periods and in peri?