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[JanineT]

Hi everyone,
I’m returning to the forum after a hiatus where I was exploring other possible causes for my ongoing, debilitating symptoms.

Quick background: I’m 52 and have been post menopausal approx 6 years.   Back & forth to drs in an attempt to get to the bottom of my symptoms which include overwhelming fatigue, widespread pain, brain fog, waking with a heavy-headed, hungover type feeling.  Generally feeling gross…..You get the idea. 

I’m currently on Evorel conti patches plus 2 pumps of oestrogel.   The oestrogel was added under advice of GP because my symptoms weren’t being alleviated.   They still aren’t!   

Just over a year ago I started pursuing thyroid issues as a possible cause for my ongoing symptoms.  I’ve long since had borderline or the occasional above range results and have been seeking the help of the brilliant TUK forum on healthunlocked.  I’ve tried a range of different thyroid treatments, most latterly a trial of levothyroxine from my GP.   Long story short, I was slowly increasing my dose but hit a wall at around 62.5mcg when the side effects outweighed any benefit.   An intolerance to thyroid replacement can be caused by a host of things, not least low cortisol, which I have.   Awaiting referral to endo but that’s a different conversation.

My main reason for posting today is to seek feedback on my recent sex hormone blood test results, which I requested from my GP ahead of a HRT review appointment next Thursday.   Any insights you wonderful women have would be ever so gratefully received!

Progesterone: <1.6 nmol/L

Oestradiol 483 pmol/L

Testosterone <0.4 nmol/L (0.1-1.4)

SHBG 113 nmol/L (20-155)

FSH 16.3 iu/L
LH 5.1 iu/L

DHEAs 1.3 umol/L (0.7 - 11.5)

I’m open to changing my HRT regime if necessary and would consider going on a sequential regimen.  I’ve previously given utrogestan a really good go but I’m extremely intolerant to it.   I then tried Provera which was marginally better compared with the utrogestan but I think the fact that I was still horribly symptomatic made me request patches.   

It’s all been a bit desperate to be honest and I’m so tired of endlessly pursuing different things with absolutely minimal help from the medical profession. 

I think I have a lot going on hormone-wise but I’m looking to establish a clearer picture when it comes to my current HRT routine.   My gut feeling is that the progesterone:oestrogen ratio is off. 

So many thanks in advance, ladies!

[CLKD]

Hi.  Many find that progesterone is the difficult part of a regime. 

Has your VitD and thyroid function levels been tested recently by blood tests?

[JanineT]

Hi, yes, Vit D is optimal, thyroid is variable.   I’m certainly not done with thyroid, I’m just looking to focus my attention on the HRT side of things for now.  Whilst also being aware that it’s very difficult to assess these things in isolation! 

Do you mind me asking how those bloods look to you?  For argument’s sake, if my symptoms were purely menopause based would these bloods look like they should be providing relief (if that makes sense)?

😊

[bombsh3ll]

Your estradiol is great, I'd be happy with that.

FSH is respectable too - mainstream medicine doesn't consider this a valuable marker in monitoring therapy, however a high FSH has been independently implicated in cardiovascular disease, osteoporosis and dementia, so I personally consider it worthwhile to keep in check.

LH is of very little clinical value outwith fertility treatment.

You have no progesterone - this is not a problem, you are on combi patch which contains a progestin.

SHBG is fine.

You have very low androgens - dhea and free testosterone.

Have you considered replacing this? It may really help with the symptoms you describe (however you would need to say it was for low libido to get testosterone on the NHS).

[JanineT]

Hey there, thanks for your considered response.

The blood test (actually tests plural, I did my own private finger prick one too) states ‘progesterone’ so, just to be clear, is that a measure of the progestin I’m absorbing via the patch, rather than any I might still be producing?   I’m confused. 

What do you think of the level?

So the androgens. Yes I’ve replaced the testosterone in the past, thanks to the enlightened people at Superdrug, but these results were done off testosterone for a few weeks; I was in between prescriptions.  I’m in the process of reordering, now that I have new bloods.  That said, I have yet to find anything approaching a ‘sweet spot’ when it comes to eradicating symptoms.

DHEA.  So I had a 4-point saliva test earlier this year to measure my cortisol output, which included DHEA.  Cortisol came out as sub-optimal all day and DHEA a good way below range.   These latest bloodst are the  only other time I’ve had DHEA tested and I think I read somewhere that serum testing is a poor relation to saliva in terms of providing a true picture.  I went down a DHEA rabbit hole (just one of many, many rabbit holes I’ve explored 🫣🤯) and started supplementing using a micronised DHEA capsule.  It made me a bit jittery I think.  I’m quite sensitive to medications which could well be a consequence of the cortisol. 

I’m considering trialling pregnenalone which certain practitioners (eg Sarah Myhill) favour over DHEA because it is upstream of all adrenal hormones including progesterone and cortisol.   It’s interesting that you picked up on this as a possible cause of my symptoms 😊 Do you have any experience of using pregnenalone to address DHEA?  Or do you know of a MM’s users who have alleviated symptoms by improving DHEA and/or cortisol?

Thanks for now x

[bombsh3ll]

Hi no synthetic progestins are not detected on progesterone blood tests.

You would not expect to see any significant progesterone on your blood result as you aren't ovulating or taking any micronised progesterone.

I am on dhea myself for androgen replacement - I take 25mg sublingual daily.

My free testosterone on this is in the upper quartile for healthy premenopausal women.

Before this I had low dhea and virtually zero testosterone.

I am on a combined pill continuously for menstrual suppression (above results were on the pill) and therefore I chose dhea rather than testosterone due to both cost and the fact that there is safety data for taking dhea while on the pill, but not for testosterone.

That's not to say testosterone wouldn't be safe, but there's simply no data, and luckily for me the dhea has done the job with no adverse effects for a fraction of the price.

I have chronically elevated cortisol, so taking dhea is a good fit for me as it is downstream so can't convert to cortisol, however as you have the opposite situation it is certainly reasonable to try pregnenolone.

[JanineT]

That’s really interesting, thank you for taking the time to respond. Food for thought….