Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Anna69 on March 12, 2020, 02:24:23 PM
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I have been on estradiol (Oestrogel) and Utrogestan 200 mg for twelve days a month for the last three years (I'm 50). A year ago, after my periods stopped, I went from using Oestrogel day 5-25 of cycle to daily (two pumps/day). Increasing it to three pumps per day as suggested by my doctor has not really helped.
Lately, I've noticed symptoms such as increased sweating, especially at night, and waking up several times every night drenched in sweat. Even if it's snowing outside, I need to have my bedroom window open.
I have read that many women are not estrogen deficient but dominant, even in menopause, as progesterone levels fall much more dramatically than estrogen levels. But not sure how to decide if that is an issue in my case.
My latest labs are from February 2020. Since I no longer have a cycle I can have them done on any day of the month (as opposed to earlier when I was supposed to go to the lab on day 21 of cycle). I had labs done during the twelve day period I'm also on Utrogestan.
Results:
estradiol 37 pg/mL (ref menopause <28)
progesterone 1.0 ng/mL (ref menopause <0.2)
But these reference ranges I assume apply to women who are not on HRT. I think my results look rather low for someone on HRT?
My SHBG came back at 95 and, although in range, I've read it should not be higher than 75.
Not sure if there is a connection, though.
It would be interesting to know if anyone has used progesterone only rather than E + P to deal with problems such as hot flushes?
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hi
my estrogen level is 435 pmol
shbg was 115
so not sure to be honest if mine ok or what i?m awaiting a telephone appointment with gp to discuss and all routine appointment have now been suspended due to the corona virus
sorry not much help
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hi
i think you estrogen is to low
i use 2 pumps gel to my arms and 100mg progesterone daily
and my estrogen was 435pmol which is i think 118 pg/ml so good levels
and progesterone is 10
but i feel i need more estrogen or testosterone
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Hi Anna69
Oestrogen dominance is one of those myths..... it is only relevant in terms of peri-menopause when ovulation becomes more sporadic but the ovaries are still pumping out oestrogen. The anovulatory cycles which result can lead to thickening of the womb lining due to insufficient progesterone - hence the "dominance". Provided your womb lining is kept within normal limits by the progesterone dose and you do not have breakthrough bleeding then the balance is right.
You didn't say where you were in menopause when you started the hRT - whether your periods were still regular or already few and far between? This will give a clue as to your menopausal status ie whether post or still peri. Following the last ovulation ( and once you start HRT you won't know when that is) oestrgoen levels continue to fall quite dramatically over the next 2 years at least and maybe more so some women find they get a worsening of symptoms around this time. You flushing could be due to this.
This is probably borne out by your oestrogen results although blood tests are somewhat inaccurate. (Sammiejane the units of measurement are different so your results are not comparable with Anna's). I'm guessing you're not in UK as we measure here in pmol/l and also don't do "labs"? So your estradiol is approx 136 pmol/l which is still quite low (but higher than someone not on HRT and post-meno). I suggest you increase your dose if this is approx accurate reading and in view of your symptoms, after consultation with your doc.
Progesterone is unimportant - no need to have this measured except for fertility purposes as it is meaningless. There is no meaningful ref range once you're on HRT or post-meno. Like I said if your womb lining is normal and no bleeding then it's fine.
SHBG on its own also is not very meaningful. Would need to know units of measurement and lab range. Also usually measured in conjunction with total testosterone (in the absence of tests for free T) to give female androgen index.
I gather there is some evidence of progesterone being used for flushes but only in very high doses ie used as a pharmaceutical drug rather than as a replacement horomone - far higher than anyone would use for HRT. With your oestrogen being lower than ideal I would suggest you go for increasing this. Perhaps half a pump at a time?
All the best and hope you sort your symptoms :)
Hurdity x
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Thank you all for your input, very helpful!
Sammeljane, which brand of gel are you on? I am on Oestrogel (Besins Healthcare) 0,6% and it says in the PIL that each pump delivers 75 mg of estradiol. A friend of mine is on Lenzetto where each pump (or rather spray) delivers 1.53 mg of estradiol, so maybe asking my doctor about switching me to Lenzetto would be a good idea?
I was put on HRT seven years ago, at age 43, by a so called anti-aging doctor in Belgium (I'm in the Netherlands BTW). I was still having regular periods at the time, but those doctors use optimal age-dependent ranges and I was told mine were far from optimal...of course, by then, I would have been peri-menopausal, so more likely E dominant than E deficient, but it seems I still needed estrogen...at least I did not have any problems until the last few months, so it would seem my estrogen levels have dropped to levels where I am deficient.
I am also hypothyroid and on thyroid hormone replacement which possibly also plays a role when it comes to sex hormones?
I have read that you can use up to four pumps of Oestrogel (0.06%) daily, so that could also be an idea (two am, two pm)?
Interesting what you say about progesterone...some alternative practitioners claim it should be used to counterbalance estrogen dominance, as they claim we are all estrogen dominant due to plastic bottles, cosmetics, traditional farming methods, etc. But I do seem to need estrogen as well.
Maybe it would be a good idea to take progesterone daily instead of cyclically...I have read that it is better to take it cyclically as the body only produces high amounts of P during two weeks a month, so taking it 10-12 days a month would be more natural than taking it continuously. However, it seems many take it daily and do fine that way. Are there any additional advantage to taking it daily (for instance, will that result in more steady P levels compared to someone taking it two weeks a month, or a better E/P balance)? I am not sure how to know when to take it cyclically anymore, TBH, since I no longer have a cycle. Maybe it does not matter once there is no regular cycle...?
Hurdity, those are the test results with reference ranges:
SHBG 91.9 nmol/L (20.0-155.0)
total testosterone 0.29 ng/mL 0.10-0.70)
free calculated testosterone <0.01 ng/mL (<0.01)
bioavailable calculated testosterone (Kaufmann-Fiers formula) 0.06 ng/mL (<0.25)
I discussed my testosterone levels with my doctor at my last appointment back in October 2019, but she said that since I have facial hirsutism I should not supplement it (she prescribes Testim to T deficient patients). I cannot understand where it is coming from but have spent a month's salary so far on electrolysis (so painful that it amounts to torture but said to be very effective). I was diagnosed with ovarian cysts two years ago but was told they did not need to be treated and would most likely disappear once menopausal. They never caused me any symptoms. I understand that is not the same thing as PCOS, where androgens are elevated, and that my testosterone levels are quite low...so not sure why the facial hirsutism? I have always had this problem (I used wax for years), but it has got a lot worse in the past few years so I guess menopause plays a role...
I understand estrogen can suppress testosterone so leading to sex hormones imbalance...not sure how to interpret my T levels, though, so any input would be appreciated. My doctor merely seemed concerned with my hirsutism, she did not say my T levels were good, but I have had hirsutism all my adult life without any idea what my hormone levels looked like.
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Hi Anna69
The Lenzetto dose will have been worked out so that the standard medium dose is comparable with the standard medium dose of gel so I am assuming the Lenzetto is better absorbed ( from test results) as 2 pumps of gel contain approx the same amount ( as 1 spray).
Yes there is an interaction with thyroid function and sex hormones but it's complex!
I don't really know about the hirsutism. Like you say it is a symptom of PCOS but you have low T. Your testosterone levels do seem very low indeed, as does the female androgen index if those units of measurement are correct, so despite the hisrutism you may want to supplement but I would want to know what the cause is first. What is your libido like and what has it been throughout your life? Strange to have cysts on your ovaries and hirsutism but apparently low T. I would ask for repeat tests from standard lab equivalent of NHS ie Govt not private - I presume they were blood tests?
As for the progesterone stuff - I would ignore the alternative practitioners. All that stuff about "balance" is pretty much twaddle! And the xeno-oestrogens meaning you need progesterone. It's all designed to sell progesterone cream!
In terms of taking it cyclically or not, it depends on your own make-up - whether you tolerate it or not so it's a perosnal thing. Some of us posting on here don't like the side effects, so take it cyclically. It's nothing to do with balance. The only need for balance is to protect your womb lining. You just need to take the right dose of progesterone whether cyclically or continuoulsy that keeps your womb lining within normal limits so the choice is up to you.
Sounds like an increased dose would be good if you are still getting flushes with 2 pumps. Some prefer to split the dose to am and pm but I have no experience of this.
Soirry I can't be more helpful.
Hurdity x
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Hi Hurdity,
Your reply was very helpful indeed.
My libido has never been that strong, not even in my teens or 20s, so not sure that is a good indicator.
My gynaecologist told met it is quite common to develop ovarian cysts in the years leading up to menopause but that they do not warrant treatment if you are not bothered by them and they do not cause any symptoms.
Interestingly enough, the only thing that has enabled me to lose weight (I was diagnosed with insulin resistance a few years ago) is a supplement called Hyponidd which has anti-diabetic properties but also lowers androgens so used to treat PCOS. I then stopped it because I was afraid it lowered my T levels too much, but wonder if I should go back on it again as it really helped lower my fasting blood sugar and insulin levels.I have had a much harder time keeping my new, lower weight since going off it. I have tried berberine instead but it just does not seem as effective.
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hi
i agree with hurdity to a certain extent re progesterone i think it's individual for me i am much better balance on e and p even though i don't need p plus i have less bloating no sore boobs but last increased to 3 pumps as felt the p was slightly outweighing the e in that my skin was dryer mouth dryer and vagina but 3 pumps was to much knew instantly this morning so going for 2. 5 but this is for me what i?m finding working but still early days but on the gel alone i was crazy so i use estrogel 2 pumps applied to arms and have had better obsorbtion on my arms then when previously used on my thighs x
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Thank you all for your input, very helpful!
Sammeljane, which brand of gel are you on? I am on Oestrogel (Besins Healthcare) 0,6% and it says in the PIL that each pump delivers 75 mg of estradiol. A friend of mine is on Lenzetto where each pump (or rather spray) delivers 1.53 mg of estradiol, so maybe asking my doctor about switching me to Lenzetto would be a good idea?
I was put on HRT seven years ago, at age 43, by a so called anti-aging doctor in Belgium (I'm in the Netherlands BTW). I was still having regular periods at the time, but those doctors use optimal age-dependent ranges and I was told mine were far from optimal...of course, by then, I would have been peri-menopausal, so more likely E dominant than E deficient, but it seems I still needed estrogen...at least I did not have any problems until the last few months, so it would seem my estrogen levels have dropped to levels where I am deficient.
I am also hypothyroid and on thyroid hormone replacement which possibly also plays a role when it comes to sex hormones?
I have read that you can use up to four pumps of Oestrogel (0.06%) daily, so that could also be an idea (two am, two pm)?
Interesting what you say about progesterone...some alternative practitioners claim it should be used to counterbalance estrogen dominance, as they claim we are all estrogen dominant due to plastic bottles, cosmetics, traditional farming methods, etc. But I do seem to need estrogen as well.
Maybe it would be a good idea to take progesterone daily instead of cyclically...I have read that it is better to take it cyclically as the body only produces high amounts of P during two weeks a month, so taking it 10-12 days a month would be more natural than taking it continuously. However, it seems many take it daily and do fine that way. Are there any additional advantage to taking it daily (for instance, will that result in more steady P levels compared to someone taking it two weeks a month, or a better E/P balance)? I am not sure how to know when to take it cyclically anymore, TBH, since I no longer have a cycle. Maybe it does not matter once there is no regular cycle...?
Hurdity, those are the test results with reference ranges:
SHBG 91.9 nmol/L (20.0-155.0)
total testosterone 0.29 ng/mL 0.10-0.70)
free calculated testosterone <0.01 ng/mL (<0.01)
bioavailable calculated testosterone (Kaufmann-Fiers formula) 0.06 ng/mL (<0.25)
I discussed my testosterone levels with my doctor at my last appointment back in October 2019, but she said that since I have facial hirsutism I should not supplement it (she prescribes Testim to T deficient patients). I cannot understand where it is coming from but have spent a month's salary so far on electrolysis (so painful that it amounts to torture but said to be very effective). I was diagnosed with ovarian cysts two years ago but was told they did not need to be treated and would most likely disappear once menopausal. They never caused me any symptoms. I understand that is not the same thing as PCOS, where androgens are elevated, and that my testosterone levels are quite low...so not sure why the facial hirsutism? I have always had this problem (I used wax for years), but it has got a lot worse in the past few years so I guess menopause plays a role...
I understand estrogen can suppress testosterone so leading to sex hormones imbalance...not sure how to interpret my T levels, though, so any input would be appreciated. My doctor merely seemed concerned with my hirsutism, she did not say my T levels were good, but I have had hirsutism all my adult life without any idea what my hormone levels looked like.
Just to let you know I also have multiple ovarian cysts since my 20s, hirtuism since then and zero T on tests! I take T daily now.
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My gynaecologist told met it is quite common to develop ovarian cysts in the years leading up to menopause but that they do not warrant treatment if you are not bothered by them and they do not cause any symptoms.
Hiya annie 69.
I hope you dont mind comnenting on this. I Just wanted to say the vast majority of cysts are indeed benign but not all benign cysts are the same.
Functional cysts are part of the way the ovaries work in fertile years.. they can be problematic in particularly in certain conditions but usually benign and usually resolve spontaneously.
There are also many types of non functional cyst and the vast majority of these are also benign and dont necessarily require treatment unless large or causing symptoms or affecting ovarian function.
Post meno the growth rate can indeed slow down, stabilise or even shrink for some types of cyst... but not for all. Dermoids for instance do not resolve in fertile years and do not get smaller post menopause. Size is a considerstion in benign cysts because there is an increased risk with large cysts of rupturing or causing torsion. Both these situations are a medical emergency.
I feel It's important that any new post meno cysts are investigated. Functional cysts are not common post meno. I stress again that statistically the majority of non functional cysts are benign but it would be remiss of me not to mention that some types albeit a relatively small number are not.
a trans vaginal scan is initially used to look at cysts. Many require no action. . if size is a consideration it may be monitored. If there are any doubts about the features of a cyst at trans v then follow up should be done. further tests may be carried out and a risk assessment may be done to decide management of the cyst.
Again, I hope you dont mind me saying this but I feel it's worth saying.
Xx
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Hello ladies
Regarding cysts my MIL had a large cyst removed when was 63. It had caused some pain and she was scheduled for a hysterectomy however it suddenly became twisted and she needed emergency surgery. It was only after her operation that she was told it was benign and it weighed 9 pounds! MIL was always overweight despite constant dieting and exercise but she had few menopause symptoms and never needed HRT. My own mother was small and slim, never took HRT but also had a hysterectomy at 50. She had fibroids which caused flooding and a benign ovarian cyst the size of an orange.
Take care ladies and stay safe.
K.
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Thanks to all who replied!
My gynaecologist does a pelvic scan every time (I see her every three months), and if one cyst has disappeared on the right ovary another one has appeared on the left...but the number and size of cysts are pretty constant. The doctor does not consider any treatment necessary at this point.
As for possible PCOS, I have read that the most telling symptom is irregular or absent periods, and that is why this condition is often discovered when a woman is treated for infertility. My periods have always been regular. Heavy, horrible, yes, but always regular. That combined with the fact that I have low testosterone levels would more or less rule out PCOS, wouldn't it?
However, someone on a thyroid forum suggested some of my symptoms (restless sleep, increased resting pulse, high blood pressure, recent weight gain, diagnosed insulin resistance) could be indicative of high cortisol. So I ordered a 24 h saliva test and have been waiting six weeks for the results. They finally arrived. And they show slightly elevated cortisol throughout the day (samples from 7.30 am, noon, 4 pm and 11 pm (bedtime)). I read that excess cortisol levels can also cause hirsutism, along with all my other symptoms.
A few years ago, my functional doctor diagnosed me with adrenal fatigue and put me on hydrocortisone (20 mg daily). Back then, it seemed like an easy solution, but now I am not so sure...after a couple of years on it, I was afraid about long-term side effects so weaned myself slowly off it. But it seems that although it's common for steroids to suppress adrenal function, they can also overstimulate the adrenal glands in some patients? I have not taken HC for almost two years, but my cortisol levels are still slightly out of range...
So I am thinking the hirsutism is more likely caused by highish cortisol levels rather than high T as my T levels have always come back in range, but slightly low in range, but never even close to the upper normal range...apart from the annual blood tests, I also had a 24 h urine analysis when I first consulted the function doctor. This revealed low thyroid and sex hormone levels.
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Hello aga ladies
Anna69. - I am not sure how relevant this is but when I was given steroids for an autoimmune disease I was told to take them for as shorter time as possible and to wean myself off them gently. It seems that when the body detects extra steroid hormones the adrenal glands down regulate their production. If we suddenly stop taking the meds the adrenals can't make up the shortfall quickly enough and we can become very ill.
I expect your situation is different but I wanted to mention my experience with steroids just in case it is helpful.
In December last year I developed hypothyroidism and was put on Levothyroxine (T4) and my thyroid levels are now in the normal range. Perhaps check your results to make sure that your low thyroid is not being properly controlled.
Take care.
K.
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Saliva tests prove nowt. Did U pay for it? I don't think the NHS provides this type of testing?
Cortisol is the waking hormone. It gave me dreadful problems when I was depressed - from 3.30 a.m. :'( ......... where did you read the info about cortisol :-\.
My Mum had polymyagia-rheumatica and was treated with steroids, her body swelled for a while. She had to be weaned off under supervision, steroids are not drugs to play around with but used correctly, can enhance the body's coping mechanism.
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I'm not in the UK, but ordered the saliva test from a UK laboratory (Genova Diagnostics). And yes, I paid around 130 GBP for this analysis.
I have read about cortisol issues on many sites...to name but a few: Stop the Thyroid Madness, Thierry Hertoghe's website www.hertoghe.eu, TPUK, Amy Myers, Westin Childs (functional US doctors)...also, British doctor B. Durrand-Peatfield mentions it in his book "Your thyroid and how to keep it healthy"...but he advocates using hydrocortisone for a very short time....a few weeks or maybe a couple of months. I stayed on it for two years and would still be on it if I had not weaned myself off it. I just did not feel comfortable staying on it any longer after reading about all the potential side effects...even on a so called "physiological dose"...
When I compare photos pre- and post-cortisone I can see that I have a much more "androgen" look now...which is a bit surprising considering my testosterone levels are well within range. But my face is now more square than oval (much more pronounced jawbone...related???), and I have been fighting to get rid of this "mustasch" for years...also a sign of PCOS/too much male hormones according to my sources. Plus, my skin is so oily it is shiny, and I have been trying to remedy that by buying all sorts of skin care products. So far, without any luck.
I guess this is all about the chicken and the egg...in my teens, in the mid 1980s, I had terrible sugar cravings which I gave into. I spent the next 20 or so years yo-yo-dieting...up 30 kgs, down 30 kgs, up 20 kgs, down 20 kgs...and so on and so on. Every time I saw a doctor I was told that I was "chubby, but not alarmingly so", and that things would normalise once I went on low fat diet and started exercising...although I was working out like crazy.
When I was 21, I went to see a doctor to get birth control pills because I could not stand my periods. They were not painful, but horribly heavy, and would last for +/-10 days...the doctor checked my blood pressure and said that, since it was borderline hyper, she could not prescribe the drugs...I spent the next ten years dieting, losing weight, gaining weight, losing a little less weight, gaining even more weight...until I was diagnosed with hypothyroidism (Hashimoto's) in my late 20s. Thyroid hormone replacement resolved some symptoms, but far from all.
My whole life, I have had borderline high blood sugar and insulin, but was told it would all go away "once I was on a low-calorie diet and exercising enough". In the years since, I have sometimes exercised to the point of ending up exhausted (jogging for up to two hours a day) without getting any results, while doctors told me I should "get my act together and start moving".
Looking back, and having read all the books and articles that I have now (written by patients or functional doctors), I am asking myself this: in my teens, did I start to overeat high carb foods because I lacked character, or simply because I was suffering from some hormonal disorder already in those days, causing blood sugar disorders...? Of course, there is no way of telling.
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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...
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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/
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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!
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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
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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...!
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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!
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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.
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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?
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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.
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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!
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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...
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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.
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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.
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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...
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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
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Hi Anna, hi Wrensong (Hope you are well!)
Anna you are in good hands when it comes to advice as I've been lucky enough to have Wrensong helping me in the past too :)
I just wanted to add my pennies worth of support really since I'm 51 hypothyroid (Hashimotos) and have also been struggling to find the right thyroid/HRT combo for quite a few years now. I was on oestrogel (5 pumps daily as I absorbed poorly) with Utrogestan 200mg vaginally 7 days a month and suffered terribly with the fluctuations. I'd be ok when on Utrogestan to start with but it would build up in my system and I'd feel like I was in a coma. I'd have a withdrawal bleed when I stopped progesterone each month but then I'd feel totally shocking, crashing terribly notably after taking my thyroid meds. I'd only feel human for about one week a month when I just had oestrogen in my body.
So, I've very recently decided to try a Conti regime and almost 3 weeks ago I had a Kyleena coil fitted which releases less progesterone than a Mirena coil. Kyleena slowly releases levonorgestrel (LNG) at a rate of 9ug per day versus the Mirena which releases 20 ug. I agree entirely with Wrensongs approach of looking for HRT stability as much as possible and therefore switched from Ostrogel to Evorel patches.
What has been interesting and totally took me by surprise is that I seem to absorb from the patches much better than the gel. I was on 5 pumps oestrogel so thought I'd find Evorel 100 (equivalent to 4 pumps oestrogel as recommended by my gyne) too little oestrogen but the opposite is true and I'm trying now to work out if I'm better on Evorel 75 or need slightly less.
I'm on T4 only at the moment as can't get on with T3 / it's just another variable at the moment to contend with but I found I starting to crash badly soon after taking my Levothyroxine when on Evorel 100. I was also sweating more and having insomnia. Once I dropped to Evorel 75 the insomnia disappeared as did the night sweats which is very interesting. My thyroid meds still go in a little spikily and a feel mild nausea for a while afterwards but nothing compared to how bad the thyroid meds made me feel when on Evorel 100.
I'm not sorted by any stretch of the imagination and I've not had my coil in for 3 weeks yet but I'd say hopefully signs are encouraging in terms of having more stability. This will give me a more even base to try and work out the best way forward with my thyroid meds I.e. might need to split dose my T4 or add in T3.
I owe an update on here to some other ladies interested in the Kyleena so I will repeat a lot of what I said here but just wanted to comment and support as I also know how impossible it can be to try and balance multiple hormones! I hope you find a better approach soon x
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Hi Blue Kingfisher :foryou:
Good to see you posting & to know you are feeling somewhat better after your HRT changes. It's also my experience that we get more overall stability from patches when a dodgy thyroid is in the mix & like you I've found a sequential regimen isn't conducive to this either.
Your experience so far with the new coil is very interesting & sounds really promising. As someone who struggles terribly with progesterone in all its forms I do hope this lower dose option will suit you & that any thyroid tweaking you may then need to do will be simpler for the steadier doses of sex hormones.
Take care. Everything crossed for you. :)
Wx
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Aww.. thanks Wrensong and so lovely to hear from you. It was you who suggested ages ago in the first place that I might be better off on patches as opposed to the gel and perhaps a Conti regime. it's taken me ages to pluck up the courage but I finally took the plunge with kind guidance from Mary G on a low progesterone coil option. Let's hope this all works out but I will keep you posted :thankyou:
Blue xx
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Thank you so much, Wrensong, for your words of hope and encouragement! It really means a lot to me!
The 25% higher the previous day (conc T3) comes from several thyroid forums...Healthunlocked, STTM...they recommend taking T3 no later than 12 hours before going to the lab. If you do leave 24 h between taking meds and going to the lab, however, they say you should assume your FT3 levels were +/- 25% higher on the previous day (given its fast clearance rate), so the actual lab result should be considered "a false low" if you leave 24 h between NDT/T3 and labs. Hope this is clear...!
I was diagnosed with Hashimoto's in 2001 and spent 10 years on levothyroxine only, ending up on 200 mcg daily without much symptom-relief. Labs from back then show low-normal TSH, top of range FT4, and low FT3. But, back then, I had no idea how important it was to correct mineral and vitamin deficiencies, so my T4 to T3 conversion could have been affected by those as well.
When I was put on NDT nine years ago, I seriously think I needed it. But, like I said, that was before I corrected deficient vits D, b12, iron, zinc, magnesium, ferritin...I now know all of those need to be at a given level in order for T4 to T3 conversion to work properly.
I think you are right about needing another doctor. I will look for reviews by other patients close to where I live, as I would not just want to see anyone...I'd need a really knowledgeable doctor who actually listens to me and takes my symptoms seriously, especially since there is also a thyroid disorder in the picture. Unfortunately, from what I can tell by visiting some forums, it seems many doctors still don't take menopause seriously, so I'd need to make sure my doctor knew what s/he was doing...it would be great though to find a doctor to manage all of my complaints...!
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Blue Kingfisher,
Thank you so much for your input and helpful suggestions!
Your experiences are really interesting; I will do some online research to see if I can find a doctor close to where I live who works like that.
What you say gives me hope that there is a solution for everyone, you just need a knowledgeable doctor working with you...!
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Wrensong,
PS. Looking back, I wish I had known then what I know now...that is, not to switch to T3 or NDT without exploring other possibilities first, but rather try to correct nutritional deficiencies first...it seems that can restore normal T4 to T3 conversion in Hashi patients. The doctor diagnosed low vits D and B12, low iron, ferritin, zinc, and magnesium, but still suggested I go straight to Armour...which, looking back, may not have been all that smart.
it's possible that 200 mcg of levo (that I used to take before switching to Armour) could have worked, had we corrected my nutritional deficiencies first...of course, I have no way of knowing that now, but it's an interesting thought...I have been considering going back on levo only (still have some left) and see if I react differently now that I'm on all those supplements...if I do feel well on it, labs could confirm I no longer need to be on NDT, but that my body can convert enough T4 to T3. I have read about people like that; that is, having to switch to T3/NDT because of nutritional deficiencies, but then feeling fine on T4 only once those deficiencies were corrected. Just an idea...
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Anna, that is a very interesting idea & I've also heard of patients who are able to return to T4 alone, though when I've suggested this to my current, extremely knowledgeable Endo, he has always felt it wrong for me to try. In fact he's always wanted me to increase the amount of T3 I take, adding a 2nd & possibly 3rd dose daily but I can't tolerate more at present & he understands that.
Prior to meeting him, desperate to feel better, I experimented with nutritional supplements known to facilitate conversion of T4-T3 during the many years post-thyroidectomy when I was unwell on T4 alone but couldn't get anyone to prescribe the T3 I needed. I could not make supplements work well enough to correct the conversion defect & it's pretty much a Russian roulette approach if no-one is actually monitoring our T3 while we're doing that. I found magnesium & selenium were powerful & felt especially tricky in that respect. Zinc also caused me probs after a while. Having got the experimental T shirt & knowing how uncomfy it was, I now always urge caution/vigilance with any thyroid patients thinking of trying supplements!
A decade or so after starting Thyroxine, I was lucky to have my request for Endocrinology referral agreed (what a sorry state of affairs it is when luck has to come into it) & to meet the right young NHS Endocrinologist at the right time to get the chance to try T3. He was enrolling patients with a suspected conversion defect onto a study where T3 was added to their Thyroxine. Up to that point, on the few occasions I'd been able to persuade anyone to test my T3 it was always low & I had the symptoms to show for it - except that I was underweight which made GPs think I couldn't possibly need T3. I felt so much better within a few days of starting the T3 trial (& as thyroid patients know T3 is that fast acting) it was as if someone had suddenly switched on my body. I, my partner & the supervising Endo were delighted, but it would have been depressing to dwell on how many wasted years I'd had, simply because I was among the 15% of patients who cannot adequately convert T4-T3, when most medics hadn't believed that's even a thing. Unfortunately the T3/T4 combo trial only lasted 12 months, the doctor overseeing it left & his replacement felt T3 was a dangerous medication patients should not have. I was taken off it & back to square one.
Perimenopause then hit like a sledgehammer, which on top of the thyroid being poorly controlled, began a very long & hellish period of extreme, frightening & very debilitating symptoms. I sought out a maverick private doctor who put me straight back on T3, then as we couldn't get the T4/T3 mix right, suggested I try Armour. It was unfortunate that this coincided with the sex hormone chaos of peri & even more so that this lovely doctor passed away suddenly before we could get my thyroid meds stabilised.
No-one was really sure whether it was thyroid, menopause or the combination making me so unwell & I was too afraid to continue to take T3 without medical support, so I stopped & went back to T4 alone. The truly hellish symptoms continued for more than a decade, during which I had 2 inpatient episodes for serious conditions & had become very run down through lack of sleep due to the really severe menopausal overheating I had every night for that long period.
I'd avoided HRT for several medical reasons (thyroid compatibility, migraine & a chronic benign breast condition among them) but mostly out of fear of breast cancer from which my Mum had sadly died. But when symptoms were still showing no sign of stopping several years postmenopause, I was on my knees & had had enough. I sought opinion from a top private Endocrinologist & a private Gynae specialising in menopause, both of whom felt HRT was right for me. The first thing the Endocrinologist did was test my T3, which of course was below bottom of range & my oestrogen, very low @ <44. He started me on T3 again straight away & we worked at stabilising the thyroid for a few months before adding HRT to the mix.
I was on combined continuous HRT of various types for a couple of years & somewhat better for it, but still unable to find a good enough fit, when I had to stop for several episodes of surgery & went 15 months without any HRT, only starting again in Spring last year. During that very stressful period the NHS had tried to stop my entitlement to T3 (as sadly they have for many patients) & my Endocrinologist had to write to the regulatory body involved stating I meet the criteria for NHS prescription to get it reinstated.
With other chronic conditions in addition to the hypothyroidism, I'm still trying to find an HRT regimen that adequately controls menopause symptoms more than 15 years after they first began, but also better with HRT than without! Testosterone was added in Jan & this has made quite a difference, but as I had BSO in 2018, I'd lost a major source of T, so it was really much needed.
I think if you want to try going back on T4 alone & can afford to see a new specialist I'd do what you suggest & research carefully before making your choice. The last thing you want to do is waste more time & money seeing someone who is unsympathetic or not knowledgeable enough to look at the whole menopause-thyroid-insulin resistance picture. I think it needs to be someone who is in it for the long run too, so that you have all important continuity of care. Not that I'm suggesting you'll go on feeling this bad for ever, but none of us knows how long our menopause transition is going to be & I certainly feel reassured knowing I have a good Endocrinologist's backup to take HRT for as long as I need it. With such persistent symptoms & osteopenia to consider I suspect that's likely to be for life. Sorry this has been an epic post but I hope hearing my history might help you feel a little less alone with your situation.
Wx
P.S. just realised how far off topic this has gone. Apologies, I know some members object to that but still there's the dilemma of how do we help each other if a tangential issue seems to be possibly implicated in the problems a poster is asking about?
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Morning! We likes a meander we does ;).
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Morning CLKD ;D Thanks for the thumbs up!
Wx
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Wrensong,
No, I don't think it's off topic at all! All hormones are related. I resent the approach of many mainstream doctors to just treat one hormone deficiency at a time, not seeing the whole picture. it's like pulling one leg off a three-legged stool and expecting it not to wobble.
I have come to realise that weight gain and the inability to lose weight even when optimally treated with thyroid hormone is often related to high insulin (insulin resistance) and/or cortisol issues. I have found that to be true as not even T3 made my weight budge. The only thing that has enabled me to lose weight since my thyroid diagnosis 19 years ago has been adding supplements to lower blood sugar levels and improve insulin sensitivity. Lately, highish cortisol levels have messed me up pretty badly, and I have been struggling to lower them as high cortisol will make weight loss impossible.
So you have had a thyroidectomy? A total one? In that case, you are not making any T3 on your own, which could explain why you felt better when adding some to T4.
it's often recommended that patients who've had a total thyroidectomy (TT) or RAI take T3 in addition to T4 as they are no longer making any T3 on their own.
it's often assumed that patients with Hashimoto's, such as myself, are able to produce all the T3 they need (ca 10 mcg daily), and that all they need is to add some T4 which the body will then convert to T3 as needed. I have found that not to be true. Of course, correcting nutritional deficiencies can be helpful in some cases, but Hashimoto's a chronic disease slowly leading to complete destruction of the thyroid gland. A person with end-stage Hashimoto's is in the same situation as someone who's had a TT or RAI, and I believe they need both T3 and T4. The real problem in my opinion is finding the optimal ratio for the individual patient. And, of course, hormone needs are not static but will change over time, and that makes it even more complicated.
I remember reading in an article someone published a link to on a thyroid forum that it is impossible to restore complete euthyroidism at cellular level using T4 only drugs in patients without a thyroid gland, meaning some T3 is required to achieve that.
Of course, the lab analyses don't show what happens at cellular level, they just show how much thyroid hormone is present in the blood. But that does not tell us anything about how much of those hormones actually enter the cells where metabolic activity takes place. That would be the reason many patients remain symptomatic despite "optimal lab results" on levothyroxine only.
Today, I lowered my Armour to 2 grains, and added 37.5 mcg of T4 to compensate for the 38 mcg in that removed grain of Armour. I don't want my FT4 levels lower as they are already at the bottom of range on 3 grains daily. Even though some say T4 is inactive and irrelevant when on T3/Armour, I have found that not to be true. I need my FT4 levels around midrange even on NDT. It would seem the brain cannot use T3, but requires T4 that is then converted to T3 inside the brain itself. That could explain why I tend to feel more depressed when my FT4 levels are low (despite highish FT3). It would seem FT3 and FT4 perform different tasks in the body, so are not interchangeable (that is, you cannot compensate for low T4 levels by increasing FT3 levels). I will now focus on raising my FT4 levels.
Anyway, I already notice my heartbeat slowing down and the sweating decreasing by ca 75%, which would point to being hyperthyroid from taking too much T3. After all, a decrease in T3 is the only thing that would produce results this fast. I have also stopped the Utrogestan, but am not sure how fast I would notice any results from that. Of course, this means I cannot take estrogen either. But, since my problems definitely got worse since going on Utrogestan, I believe you are right and that Utrogestan has indeed been part of the problem.
For most doctors, taking T4 only seems to be the goal, no matter how the patient feels. That's because they tend to look at the TSH only and not pay attention to the actual thyroid hormones - free T3 and T4.
My impression is that most mainstream gynaecologists specialise in pregnancy and infertility, and are not really knowledgeable about menopause. it's like most endos seem to specialise in diabetes and not know enough about thyroid disease. Those endos tend to prescribe T4 only and declare the patient cured once the TSH is anywhere in range, and I suspect many gynaecologists don't know enough about the various forms of HRT available. So, if I decided to switch doctors, I'd need someone specialising in menopause specifically, and who truly understands how much discomfort this can cause and how it can wreak havoc on your life. Unfortunately, I get the impression my current gynae thinks that menopause is just something you have to suffer through as it's normal...
The doctor I see once a year specialises in anti-aging medicine which is not a recognised specialty in many countries. This means ordering a lot of tests - thyroid, sex hormones, glucose & insulin, vitamins, minerals, liver & kidney function, lipid profile, growth hormone etc...but then, the doctor does not really have time to go through all of those results in one hour, so tends to just renew prescriptions unless something is really off. But minor changes in hormone levels tend to go unnoticed...no doubt because the doctor is stressed as two more patients are already waiting and she's almost an hour behind schedule. That's always the case, and tells me this doctor books too many patients in a day.
I think it would be better to see one doctor for thyroid-related matters, one for menopause etc.
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Hi again Anna,
I resent the approach of many mainstream doctors to just treat one hormone deficiency at a time, not seeing the whole picture. it's like pulling one leg off a three-legged stool and expecting it not to wobble.
I think that's a great analogy!
I wouldn't say never use supplements - would be hypocritical of me since I have done & still do use some at low dose - I usually merely say to be aware they can have powerful effects, which are not always beneficial & can get us into trouble. I worry that there's sometimes a sense that anything we can buy from a healthfood outlet is "natural" & therefore safe or safer than regulated & tested prescription medication supervised by a qualified medic. You've found what works for you as regards helping stabilise your blood sugar in relation to conditions you described I think as borderline insulin resistance & raised cortisol. That's beyond my experience & if you're confident you know what you're doing that's up to you. But I think it's natural to feel protective towards other women as well as wanting to help empower each other, when we know what a difficult time menopause is & how desperate that can leave us. So I feel a responsibility chatting to people I haven't met in person, conscious that we can never really be sure of another's physical or emotional state - only what they choose to reveal/portray. Our vulnerability at this time of our lives worries me, if you like.
My thyroid surgery was hemithyroidectomy 25 years ago, for what was thought to be a single suspicious nodule. Turned out to be a non-toxic multinodular goitre caused by Hashimoto's. But the remaining gland is said to atrophy on replacement.
"In that case, you are not making any T3 on your own"
My understanding is that only about 20% of T3 is said to be made by the healthy thyroid, though I believe the proportion can change under disease conditions & that the rest is produced by conversion/deiodination in peripheral tissues (liver etc).
"it's often assumed that patients with Hashimoto's, such as myself, are able to produce all the T3 they need (ca 10 mcg daily), and that all they need is to add some T4 which the body will then convert to T3 as needed. I have found that not to be true."
Yes, there seems to be a widespread misunderstanding that everyone can convert T4 adequately. But bloods have consistently shown I can't convert well enough to take T3 up above bottom of ref range. As mentioned earlier there is a significant subset of patients who have what they term a conversion defect.
"The real problem in my opinion is finding the optimal ratio for the individual patient. And, of course, hormone needs are not static but will change over time, and that makes it even more complicated"
Agreed on both points!
"Today, I lowered my Armour to 2 grains, and added 37.5 mcg of T4 to compensate for the 38 mcg in that removed grain of Armour."
I appreciate you're very experienced & know what to look out for, but please be careful if you're making adjustments before discussing it with a clinician. As you know, the sudden reduction in powerful T3 may be very noticeable in the short term before the T4 you are substituting has a chance to build up. Potentially no bad thing if your T3 has been too high though. Let's hope you're on the right track.
"I already notice my heartbeat slowing down and the sweating decreasing by ca 75%, which would point to being hyperthyroid from taking too much T3. After all, a decrease in T3 is the only thing that would produce results this fast. I have also stopped the Utrogestan . . . Of course, this means I cannot take estrogen either "
Making 4 changes at once :o (reducing T3, adding synthetic & reducing natural T4, stopping progesterone, stopping oestrogen) could make it more difficult for you to judge what's been the root cause of your horrible symptoms. But I understand your reasoning & desperation. If you're stopping the HRT suddenly you'll also know you may well get withdrawal symptoms from that, so continue to sweat & flush badly, which could carry on into the longer term due to then being even more sex hormone deficient. But you are already in an unpleasant situation with horrible symptoms so I get where you're coming from.
"My impression is that most mainstream gynaecologists specialise in pregnancy and infertility, and are not really knowledgeable about menopause. it's like most endos seem to specialise in diabetes and not know enough about thyroid disease. Those endos tend to prescribe T4 only and declare the patient cured once the TSH is anywhere in range, and I suspect many gynaecologists don't know enough about the various forms of HRT available."
Sadly a situation many of us come up against, which is why we find ourselves shopping around.
"I think it would be better to see one doctor for thyroid-related matters, one for menopause etc."
I've been lucky that my Endocrinologist is happy & able to oversee the lot, but I've still felt the need to be as well informed as I can because I want to be fully involved in decisions about my care. Please do try to see a clinician who can work with you Anna, sooner rather than later, especially if you're making major changes to essential medication, rather than struggle to sort out a very complex situation alone. :bighug:
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Wrensong,
You?re right, it's not a good idea to change several things at a time which I did out of pure desperation.
I went back on Lenzetto, but will resume taking Utrogestan cyclically rather than continuously (since the problems got worse after I started taking it daily). Hopefully, that will make symptoms tolerable until I can find a good doctor knowledgeable about menopause.
I never did well on levo only, but that could have been caused by low vitamin and mineral levels. In a way, it's a shame doctors did not try to correct those before switching me to NDT...now that I've taken NDT for some years, I'd be reluctant to go off it completely. Worst case scenario: I'd end up hypo once more.
I have decided to order a DUTCH test (dried urine) to see what my cortisol levels currently look like...one problem when taking supplements to lower cortisol is that you risk ending up with too low cortisol...which could be even more problematic as it would affect thyroid hormone absorption. So I think I need to know where I stand so I just don't take supplements to lower cortisol if my levels are actually lowish as a result of taking adaptogens...
Once again, thank you for all your invaluable advice and support :thankyou:
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Bless you Anna :foryou:. I think you're wise to make fewer changes all at once, but I so understand your desperation - been there myself & for far too long. But don't lose hope - it will get better as you go further through menopause & your own hormones plateau. The fluctuations that cause so much havoc will be behind you & it should then be easier to combine HRT with your thyroid meds. Many of us find the worst time is during peri & for a while when we're first into postmenopause when the body's learning to adapt to the new normal. I really hope you manage to get to the bottom of what's going on soon, so you can turn a corner & feel the relief when you know you're starting to feel a whole lot better. Please let us know how you get on & good luck finding someone who knows what they're doing & has the time to listen & work with you.
Wx
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OK, so I just got the labs back my gynaecologist ordered. I had them while still on Lenzetto (two sprays a day) plus Utrogestan 100 mg daily at bedtime. The results are really bad (IMO):
Estradiol <6 (<8 menopause or at least 12 months since last menstrual period)
Progesterone 0.1 (<0.2 menopause or at least 12 months since last menstrual period)
FSH 18.6 (menopause >27)
LH 10.0 (menopause >5.2)
prolactine 8.0 (ref 5.2-26.5)
So, FSH and LH indicate not yet menopausal, whereas E and P do...T not measured.
I have been having irregular and sparse bleeding in the past year, so not sure when to say "at least 12 months since last period".
Anyway, my gynaecologist said that both transdermal estrogen and micronized progesterone are problematic as there are absorption problems...it seems that micronization(?) was the only way to make oral bio-identical P absorb better, but my doctor said it's still not as good as progestins...plus, oral estrogen absorbs better. Whereas my functional doctor avoids progestins like the plague.
Given my symptoms, and my labs, she put me on Kliofem (continuous HRT). I will take one pill daily and it contains estradiol/progestin in a 2mg/1mg ratio.
Of course, my gynaecologist is a conventional doctors so does not believe in the miracles of transdermal HRT, but I have to admit I have become more and more skeptical...at first, it sounded wonderful when my functional doctor told me that transdermal E and micronized bio-identical P meant I would never suffer from any of the side effects of traditional HRT...but the fact is that I have not done well on this regimen. The night sweats and the hot flushes have become especially troublesome, and not even going up to three pumps of Lenzetto daily has solved that.
I don't know...my gynaecologist assured me Kliofem is safe, effective, and should work much better than transdermal E + Utrogestan. She also said that the concerns about HRT and especially oral estrogen are unfounded, and that oral E used to contain much higher doses of E (back in the 1950s and 1960s). She said today's drugs contain lower amounts which are more bio-identical so will not cause the same problems.
I have decided to give Kliofem a try...I mean, if it does not work out, I can always go off it...the doctor said to give it three months and then come back. I guess three months of oral E + progestins are not going to kill me...?!
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Anna69, your oestrogen levels are extremely low, even allowing for daily fluctuations. When I was using three pumps of Lenzetto, I had blood levels of around 300 pmol so it sounds like you are not absorbing it and you need to switch to something else.
That's why it's a good idea to have blood tests when using HRT, it's the only way to know how well you are absorbing it.
I would definitely give the Kliofem a try, you have nothing to lose and may find it works well.
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Anna, if you are not absorbing the transdermal oestrogen then I'd say you have little to lose by trying the Kliofem. I think you said oestradiol patches didn't stick well & if I remember rightly you tried gel as well as Lenzetto? Can I ask were you taking the Utrogestan orally or vaginally?
In your position with such troublesome symptoms, I wouldn't worry about the comparably slightly increased risk profile you mention from oral HRT.
my functional doctor told me that transdermal E and micronized bio-identical P meant I would never suffer from any of the side effects of traditional HRT
Plenty of us get side effects from transdermal regimens, so dare I say your Functional Medicine specialist is wrong if she thinks they are guaranteed side effect free!
What I would just bear in mind though, is that oral oestrogen increases Thyroid Binding Globulin, effectively reducing available thyroid hormone & as you have recently cut your dose of Armour I'd be vigilant for any indications that hypothyroid symptoms are coming back. You can always take a little more thyroid hormone to compensate if necessary.
I hope you find you absorb better from the Kliofem & that symptoms reduce as a result. :)
Wx
P.S was posting at same time as Mary G but see we are in agreement!
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Hi Folklass, yes Anna has told us she's in the Netherlands.
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Yes Folklass, I wondered what was going on with the different ref ranges a few pages back too! ;D
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Thank you all, I am in the Netherlands which would explain why my labs seem a bit off sometimes...! Sorry, I have no idea what the reference ranges or measurement units are in the UK.
Wrensong, thank you, that's very reassuring! I have never taken Utrogestan vaginally, only orally (100 or 200 mg soft capsules) depending on whether I was taking it cyclically or continuously (cyclically = 200 mg daily for days 16 to 28 of cycle at bedtime; continuously = 100 mg daily at bedtime).
I think my gynaecologist is right, and that taking Kliofem for a few months is not going to kill me..if it does not work, no harm done, I can just go off it.
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Wrensong,
About oral estrogen and thyroid hormone replacement - yes, thank you for pointing that out! I am due for thyroid labs in early September so will keep an eye on it most definitely! I will start on Kliofem tomorrow so eight weeks should be enough to tell...
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Folklass,
Not a problem:-) as most members seem to be in the UK...!
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Folklass, will add that asap; don't think editing posts is possible so will add new reply.
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Folklass, will add that asap; don't think editing posts is possible so will add new reply.
If you go to your post, on the upper right hand corner there is an icon that says modify.
JP x
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First of all:
Thanks to everyone who responded and provided feedback!
Ok, sorry, here are my results with measurements units:
Estradiol <6 pg/mL (<8 menopause or at least 12 months since last menstrual period)
Progesterone 0.1 ng/mL (<0.2 menopause or at least 12 months since last menstrual period)
FSH 18.6 UI/L (menopause >27)
LH 10.0 UI/L (menopause >5.2)
prolactine 8.0 ng/mL(ref menopause 5.2-26.5)
Once again, sorry for not thinking about the different measurement units and reference ranges in various countries...!
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Joaniepat,
Thanks, good to know!
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Don't worry Anna, you have always given the ref range alongside your results, so we could see whether within expected range, even if the ranges have looked a bit odd :o to us in the UK!
Wx
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Anna, thanks for confirming your Utrogestan was oral.
Folklass - I originally joined the thread without noticing there had been an earlier page ::) & asked poor Anna what must have been tiresome questions she had already answered ;D
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Anna69, my blood tests are pg/mL too but I convert them to pmol for MM purposes!
Your oestrogen reading is still very low and 6 pg/mL is about 22 pmol which is very low for three pumps of Lenzetto. To give you an idea, mine were about 80 pg/mL on that dose.
I'm sure you will do better with the Kliofem.
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Thanks to you all :)
I am going to give Kliofem a try, as I have nothing to lose it seems...transdermal estrogen has not been that great, nor has oral Utrogestan...and I think that is where I have to start. I was told transdermal estrogen and Utrogestan was all I'd ever need...and now I am not so sure. Perhaps there is some truth to what my gynaecologist told me...I guess only time will tell. But I am not as afraid to go on oral estrogen and progestin as I might have been last year...!
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Yes, I considered Tibolone, but it is said to have "weak estrogenic, progesteronic and androgenic properties", so not sure that would be enough for me right now, as it feels like I am going through the most difficult phase at this moment. it's said to last a couple of years and then worst will be over...at which point Tibolone might be an interesting alternative. But right now, my estrogen levels are very low which is probably causing the heavy night sweats and hot flushes, and I am not sure Tibolone would be enough for that...it is said to be more effective than placebo, but less effective than HRT.
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Not sure which...I had irregular bleedings until a couple of months ago.
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So, after a week on Kliofem I have developed side effects I never had with transdermal estrogen - acne and swollen, tender breasts...plus no visible change in symptoms, but I guess that cannot not be expected after a week (with any form of HRT).
However, it seems oral estrogen has some unpleasant side effects that transdermal E doesn't, which makes me wonder if the best solution would be to go back on Lenzetto three sprays a day and see what happens? According to the conversion charts I've found, two pumps of Estrogel (which I was previoulsy on) equal 1 spray of Lenzetto, so three sprays of Lenzetto should logically equal six pumps of Estrogel...?
Then there is the problem of progesterone...but I realise I handled cyclic P better than continuous P. So maybe I should just take Utrogestan 200 mg for twelve days a month, instead of 100 mg daily, and see if that makes a difference...I no longer have regular periods so the exact days should not matter so much any more.
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I don't know how much withdrawal bleeds I will have since I am 51 and periods have been irregular for the last two years. Last lab results showed FSH and LH indicative of post-menopause, plus ovaries are atrophied according to gynaecologist, so logically bleedings should stop soon on their own anyway...?
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Yes, because the Kliofem rapidly resulted in side effects I've NEVER had while on transdermal estrogen...like acne all over my face and very swollen and tender breasts. I don't know if all women using this drug experience this, but I find those side effects most unpleasant. It feels like I've increased almost a bra size since going on it... :(
I will just go back to three sprays of Lenzetto a day and hold it there for a while...plus go from continuous to cyclical oral Utrogestan.
At some point, this has to settle down, right...?! I guess I am just going through the most difficult phase right now, and it's said to last between one and two years...but while going through it, I most certainly would like to feel as normal as possible...and waking up seven times every night drenched in sweat and having to shower about as many times a day feels like something you should not have to go through at this time and age...
However, I feel like I'm stuck between a rock and a hard place, with a functional doctor prescribing only bio-identical hormones (I'm seeing this doc because of my thyroid condition as most conventional doctors don't know anything about thyroid disease), and my gynaecologist who will only prescribe oral HRT...so far, oral estrogen has not been that great for me...I am sure it works for others, but I have to admit I was surprised to see how my body reacted to it after only a week...I have not had acne since I was in my teens, plus it felt like I retained a lot of fluid...after going off Kliofem, it feels like I've been going to the loo about 45 times a day...coincidence...?!
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Hi it could be the progesterone in the Kliofem that doesn't suit you. It is norethisterone. X
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Anna, oestrogen in any form makes me retain fluid, which I then shed very noticeably during the progesterone phase of my cycle, as prog seems to have very diuretic effects for me. But we hypothyroid ladies also retain fluid when our thyroid hormone levels are suboptimal, so I'm wondering whether you felt especially bad on the oral oestrogen because of its tendency to increase thyroid binding globulin (which we've chatted about before), effectively lowering your available thyroid hormone.
I realise with Kliofem you'll be taking both Oestradiol & the progestogen every day, but the balance of the two may not be right for you, especially given your thyroid meds have recently changed so you have several balls in the air as it were. The Norethisterone in Kliofem is also one of the more androgenic, testosterone derived progestogens, so perhaps that explains the acne.
Sorry this doesn't seem to be the right HRT for you at this time.
Wx
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Wrensong,
No, it most definitely is not. The fact is that I already feel better on Lenzetto + cyclic P (I have read that you can also take 300 mg daily for ten days instead of 200 mg for 14 days), so maybe I don't need P daily, just cyclically...
I used to be on adrenal support, and that enabled me to take a higher dose of NDT which effectively rid me of remaining hypo symptoms. Then I weaned off it after reading on several thyroid forums that taking adrenal support long-term will make your own adrenal glands sluggish, and that you need to have your cortisol measured (preferably in saliva several times a day) regularly while on it so that your cortisol levels don't go too high or too low. That is such a hassle, not to mention expensive since you also need to ship the samples using overnight carriers such as DHL. So I just decided to go by symptoms and listen to my body.
TBH, I have not felt quite like myself since weaning off the adrenal support (Thorne Adrenal Cortex) last year. I went back on it the other day, and have now raised the NDT somewhat, this time without any ill effects. So it seems I need to balance my adrenal glands as well, and that cortisol issues may very well part of the problem all along.
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Dotty,
Very likely, yes.
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Anna, I'm sorry, I have no experience of supplementation/medication for adrenal issues.
Menopause can certainly be a challenging time for hypothyroid women, with balance hard to achieve & if you have three endocrine aspects to juggle - thyroid, menopause & adrenal insufficiency, I can't help feeling you need a good endocrinologist who can oversee the lot. Is there really no-one you can ask to take a holistic approach?
Please don't give up hope. I really struggled in perimenopause & for a few years post as I came late to HRT. Now 8 years post, my HRT is still a work in progress as progesterone in all its forms is the challenge for me, but I'm persevering as QOL is too poor without oestrogen & testosterone. It does get easier to stabilise as we get further into postmenopause & our own sex hormone fluctuations settle down. Then we are just looking to redress deficiencies rather than battling erratic peaks & troughs of unpredictable duration.
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Wrensong,
Endocrinologists do not care for people who take T3 or NDT and have a lower than normal TSH. They tend to be TSH obsessed and prescribe levo only. I spent ten years on levothyroxine and it did nothing for me. However, I doubt I could find an endo near me who would accept that.
I see a doctor in Belgium trained by Thierry Hertoghe (a well-known anti-aging doctor). The doctors trained by him prescribe NDT and other bio-identical hormones. My doctor put me on hydrocortisone for a couple of years and it made me feel a lot better, but I felt uncomfortable taking it indefinitely as it tends to shut down your own adrenal glands. That is why I switched to a supplement...
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I'm sorry that's been your experience of Endocrinologists, Anna. :hug: Though I struggled for many years on T4 alone, I was never well without T3, so feel very fortunate that my current Endo decided at first appt I needed to go back on it after my previous Endo had passed away, that he's continued to champion my use & that I get on better with Liothyronine than NDT, which is even more controversial here than T3. Bloods have repeatedly shown I need T3 & I've made sure to obtain copies of the pathology reports to demonstrate that if need be. Also feel lucky that I don't need a suppressed TSH to feel my best, as I'm well aware, as you point out, that that's another controversial issue.
My Cons has the authority to continue to prescribe T3 though the NHS has tried to restrict its use following a big price hike a few years ago. It's a horrible situation for patients to be in - either refused a medication they need or feeling as I do, guilty that it now costs so much. I'm lucky though, that I only currently need a very low dose, so I'm a comparatively cheap T3 user to treat, as most patients who need it require more.
My Endo also oversees my HRT as mentioned before & that works very well for me. He is hugely experienced, widely respected & liked by other medics & patients alike. He listens & obviously really cares about his patients. The process is a partnership with my full involvement, I'm completely at ease talking to him about anything & always feel I can ask for what I need. I see him roughly every 3 months, more frequently if needed & I can email or ring him at any time between appointments. His care is so valuable to me that I just want the same for other patients & tend to encourage them to research & seek out someone recommended who will oversee the lot.
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Wrensong,
You are VERY happy to have an endo like that!!! I both envy you and am happy for you at the same time.
The functional doctor I see for my thyroid is in a different country so I only see her once a year. Of course I can email her questions, but she cannot make a new diagnosis unless she sees me IRL, so the only thing I email her about is the renewal of prescriptions. But I agree it´s far from ideal.
I seem to recall you have an in-range TSH on T3? That´s pretty unusual in my experience, but maybe it´s because you take a low dose of it...as T3 tends to suppress the TSH pretty quickly.
I have lost count of all the doctors who tried to force me off NDT and back on levo. Doctors with no knowledge of thyroid disease whatsoever, but who go by the TSH only and tend to freak out when it´s below 0...they start saying I risk a heart attack or osteoporosis.
One doctor (a GP) said to me: "I would feel more comfortable if you would go back on levo so that your TSH could normalise". Then I heard myself say: "Well, the problem is that YOU are not the one supposed to feel more comfortable, I am!"
How may other diseases are treated that way...that is, that the patient´s wellbeing and treatment response do not matter, but the only thing that does is the TSH...which is not even a thyroid hormone but a pituitary hormone???
I have seen doctors over the years who had no idea what T3 was, so did not know that T4 has to convert to T3 for symptom-relief. Doctors in general are clueless when it comes to the treatment of thyroid disease, and can only be useful to patients who do well on levo with an in-range TSH.
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Anna, yes my TSH is usually within range on the T4-T3 combo, never suppressed. In fact it's usually a bit higher than my Endocrinologst would like, but at this age I feel better with a slightly higher TSH than is usually considered optimal. As mentioned before, that was not the case in younger years - I needed my TSH to be close to suppressed before perimenopause.
I've just found out my latest TSH is actually raised, i.e. above ref range & I now have to increase my thyroid meds to bring it down. That can only be because my Oestradiol (patch) dose was increased a few months ago - this is the first TFT since then. Frustratingly, I've consistently found that taking even transdermal oestradiol affects my requirements for thyroid replacement. Conventional wisdom has it that only oral oestrogen increases thyroid binding globulin & consequently need for thyroid hormone. My feeling is, as with so much relating to hypothyroidism, they need to rewrite the text books!!
My T3 is always below bottom of ref range, despite taking it as part of my thyroid replacement meds, the latest T3 result being quite a bit below range. That's because my Endocrinologist's instructions are no meds before testing, so my last dose is always 24+ hours before bloods are done & as we know, T3 has a short half life. Yes, my T3 dose is also tiny, so there is little to show at time of testing, but it does show lowish-mid range if tested within 3-4 hours of taking T3. Really I need to take another dose or two every day as most patients on T3 do, but can't currently seem to manage this with a broken thermostat & homoeostasis so badly compromised by menopause! Now a good few years postmenopause my HRT is still a work in progress.
I have lost count of all the doctors who tried to force me off NDT and back on levo. Doctors with no knowledge of thyroid disease whatsoever, but who go by the TSH only and tend to freak out when it´s below 0...they start saying I risk a heart attack or osteoporosis.
I'm so sorry Anna, the widespread resistance towards the use of T3 & NDT is a tragedy for those patients who are unwell on Thyroxine alone. Like you, I was repeatedly warned that osteoporosis & heart disease would likely result if I continued to take the T3 bloods always show I can't make enough of for myself. What less enlightened medics often don't take into consideration is that the consequences of being on inadequate thyroid replacement are also serious. It makes me both angry & very upset that the needs of this significant minority of patients are widely disregarded.
Also seems sadly ironic that medical opinion seems to be open to the evidence that there is a very big range of responses to infection with COVID-19, from asymptomatic individuals, through respiratory & renal failure, stroke, cardiac complications etc . . . to death. And yet hypothyroid patients must all fit the mould of having classic symptoms of underactivity & respond well to Thyroxine alone. Judging by what's reported on here, many doctors seem to think that any woman not having flushes can't be menopausal either. The cynic in me wonders whether the difference in taking note has anything to do with the fact that COVID seems to have worse effects in men than women & many more women than men become hypothyroid (& menopausal!) I'm not a classic hypothyroid patient, I'm underweight & lie awake at night in a raging inferno, yet according to my latest TSH I still need to increase my thyroid medication, which will only burn off more calories . . . raising body temperature in the process. It's all so complex & I know so well the sense of isolation that results when we can't get the validation or medical help we need to recover & get on with our lives.
One doctor (a GP) said to me: "I would feel more comfortable if you would go back on levo so that your TSH could normalise". Then I heard myself say: "Well, the problem is that YOU are not the one supposed to feel more comfortable, I am!"
How may other diseases are treated that way...that is, that the patient´s wellbeing and treatment response do not matter, but the only thing that does is the TSH.
I absolutely hear you Anna & share your frustration. I nearly missed your last post & sometimes go weeks without following the forum. I hate to think of any hypothyroid patient struggling alone with worries, especially at such a horrendous time as menopause, so if you want to chat about anything & there's no-one around, please send me a PM. I try to check for those if I'm not reading the forum regularly, but strangely they don't always come through to email.
Wx
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Thanks, Wrensong, it´s always good to know there is someone to chat to about thyroid disease which is of course not the direct subject of this thread... :)Will definitely take you up on that offer some time.
I´a member of a thyroid forum, and every day there are patients telling the same story over and over again: about not being allowed to switch to T3 + T4 or NDT, about being forced to stay on a dose of levo that keeps their TSH in range regardless of symptoms, about not having their FT3 levels measured and often not FT4 either (many doctors only order TSH), about how doctors refuse to listen to them and are patronising and condescending. When their symptoms scream hypo. doctors declare them "well within range" and offer them anti-depressants, weight loss drugs, and HRT instead. Some may need HRT, for sure, but it´s true that menopause and thyroid disease symptoms sometimes overlap. I´ve learned from the forum that low thyroid hormone levels (on cellular level, regardless of what´s in your blood) can cause symptoms such as night sweats and insomnia - symptoms often associated with menopause.
I cannot help but wonder if it´s because most thyroid patients are women that it´s so easy for doctors to dismiss them...???
Talk to you soon!
Anna
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thyroid disease which is of course not the direct subject of this thread... :)
Yes we've been pretty naughty there ;D! Have been conscious of that since my mentioning it meandering a few pages back! But since it was your thread . . . & at that point you said you didn't feel thyroid issues were irrelevant to its course . . . I was happy to chat thyroid. :whist:
Glad you find the thyroid forum helpful though. I'm not a member of any other forum. Take care Anna.
Wx
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PS Wrensong. Thanks for pointing out the connecting between higher doses of estrogen and needing more thyroid hormone. Looking back, I realise I had to raise thyroid hormone when I raised my daily dose of transdermal E to deal with worsening symptoms of menopause. So there definitely seems to be a connection, although most doctors seem to think that only oral E increases the TBG levels and hence the need for a slight increase in thyroid meds.
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Well Anna, it's good to know another woman has had the same experience with even transdermal E increasing need for thyroid hormone. I knew it did with me as bloods have shown it's happened every time my E dose has been raised over the 5 years since I started HRT. You are the first person I've ever known confirm it doesn't only happen with oral E though. Thank you, makes me feel less of a freak :).
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I just read that the only reason to have periods is to clean out your womb in preparation for fertilisation...if pregnancy is not your goal, there is no need to have periods. I just want to get rid of mine...they stopped for almost six months, then came back erratically, but now seem to be back again and regular every time I go off Utrogestan (I´m 51 so this is surprising).
So, the advice given is to take bio-identical progesterone daily and in high enough doses to stop bleeding. One site I visited suggested taking 200 mg daily for three out of four weeks, then 100 mg daily during the fourth week (always with estrogen), others suggest 300 mg daily (but then without estrogen). Some functional doctors consider P, not E, to be the best cure for menopausal complaints.
I wonder if I should try this because I cannot wait to get rid of my periods for good...they have made my life miserable for the past 40 years, so I cannot wait for them to go away. Some say progestin will achieve this faster and more effectively than bio-identical progesterone, but I still prefer the latter as it protects against uterine cancer, and has an overall better risk profile.
Has anyone managed to get bleed-free using higher doses of progesterone? It would seem 100 mg of Utrogestan daily (as I have been taking) may not be enough to stop bleeding altogether, or it may take several months to achieve it.
But since my estrogen levels came back pretty low (37 ng/mL, recommended 50-100) on estradiol, I doubt I should go off it altogether...