Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: JoannFran on June 03, 2024, 01:17:03 PM
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Good afternoon
I've posted a few times about this recently, so i'm sorry if I'm repeating myself but I really could do with some advice as I feel like I'm losing it. I'm 49 and in Peri and on evorel 100 patches and utro for 2 weeks (and Testosterone). Before HRT I was suffering from palpitations and racing heart/anxiety. Since being on the HRT (also on Propranolol beta blocker) the racing heart has calmed down however I'm now getting loads and loads of frequent ectopic/missed beats.
Somedays I only have a few and then days like today I have them one after the other. Without sounding dramatic I feel like my life is ruined. I can't enjoy anything through fear of these happening. I've had all the heart tests and been told 'benign'. However, I just can't live like this anymore :'(. I am driving myself completely crazy by searching for the cause (there MUST be a cause). I thought it was to do with a histamine intolerance but they've come on today when I eaten foods that have been fine on other days. I think there's also a correlation between when my own estrogen should peak and the frequency of them (more around day 12/13 and days 21/22).
Meno Dr says increase estrogen to 125 but I'm scared to do this. I also changed patch today so wondering if that's anything to do with it? But this doesn't always happen when i change the patch. maybe it's certain times of the month when I change it?
I'm really sorry to post about this again, but any advice, any help, anything would be greatly appreciated. Thanks so much x
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Increase estrogen. I had this all the time until I got my estrogen up.
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I agree. Had this myself when I tried to change oestrogel regime. Only thing that got rid of them was a higher dose. x
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Thank you both for replying.
Just worried about the high dose. My estrogen levels were around 400 on day 3 (and weirdly 300 on day 21) 2 different labs. Doesn't really make sense as it should be the same or more on day 21? :-\
How quickly did they stop once you'd started the higher dose?
Thanks again x
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Hi merrygoround - thanks so much for your reply, much appreciated. It’s so hard to accept that they are benign when they feel so awful. And I struggle to stay calm when they happen so anxiety is through the roof, which doesn’t help. It’s so helpful knowing that other people have experienced it and it’s resolved after menopause. I can’t imagine living with this for the rest of my life. It’s consuming me!
I have a drs appointment next week so going to ask about Bisoprolol.
You said you switched to Bisoprolol. Was you on propranolol first? Any issues switching?
Thanks again for your help x
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Have you been checked for a thyroid condition?
If it is just menopause, the estradiol may well just take a few weeks to see an improvement, I would give it a bit longer as symptoms don't always go away immediately.
Like others have said, a dose increase if things don't settle is also reasonable.
How well are your patches sticking? Unstable levels can be an issue if for example you are getting the full dose on day one, half that on day 2 because the edges have lifted up, and very little by day 3 when it's hanging on by a thread?
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Hi bombsh3ll - thanks for your reply. Yes I've had my thyroid checked a number of times and been told it's fine.
Patches stick well as I put a layer of the tegaderm dressing over it. Otherwise they don't stick great.
I've upped my patch by half a 25mg so now on 112.5. Will see how it goes.
Thank you. x
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I have this too and it's really awful - I wish I could give you some solutions. Mine flares whenever there is a change in either direction to my Estrogen level. I have no idea why this would only start in my 40s (when changes to Estrogen as part of your cycle is totally natural) but there you go. A word of caution about increasing your Estrogen - for me the issues can equally be caused by too high as well as too low Estrogen (definitely the case for me a number of times) so just ensure you make any changes slowly.
I did a bit of research into beta blockers and pressed my doctor to take Atenolol instead of Propranolol, because it has a more favourable side effect profile for insomnia (which is a bit of an issue for me). Atenolol isn't licensed for anxiety and Propranolol is, so I had to push a bit but managed to get it. I take half the lowest dose tablet a day and it does really help take the edge off... it's been a bit of a life saver. If I increase to a full tablet my BP and heart rate drop a bit too low and I feel a bit woozy, so I tend not to unless I'm desperate, which I still get at times when it flares. My mum also suffered terribly from this in her 50s upwards and was prescribed Bisoprolol and this seemed to help her.
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Oh!!!!!!!! Following!!!!!!!!!!
Ectopic beats were a symptom before I started HRT and have been quite problematic the last few months. They are quite unpleasant. I was tested quite extensively pre HRT and got the all clear and they did go away until recently. I am terrified I am going to have a heart attack when they come in - its mostly at night but they are creeping into the day time. I also feel really flat and like I did pre HRT! So I suspect I need an increase from 1.5mg Sandrena which I have been for a while. I have blood tests on Friday so will see what they say but suspect i need more.
Quite reassuring to read that others have had relief from an increased dose.
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I had these throughout peri & for a few years postmeno before starting HRT, in long episodes at any time of day 24/7, but worse in evening & overnight. They resolved shortly after starting HRT 3 yrs postmeno, with a change of thyroid meds around the same time.
Agree they are v scary & can be overwhelming, but they are also fairly common in menopause, though I didn't know that until I saw a v good MS 3 yrs postmeno. They started nearly 20 yrs ago & back then there was much less awareness about the effects of menopause so the various medics I'd seen prior to this MS were not sure of the cause, which compounded the worry, especially as I also have a thyroid condition. Like some of you, I had all the cardiac tests & only benign ectopics were found.
Now 12 yrs postmeno I still get them occasionally, usually in response to a change of HRT or thyroid meds (dose up or down) but they tend only to last for a couple of weeks & are minimal compared to peri. I found Utrogestan brought them back with a vengeance though & couldn't take it due to this & other horrible side effects.
Controlled breathing, regular meditation & anything that promotes relaxation can help bring about a calmer default state & reduce the emotional havoc they can wreak. There are many, many threads on here discussing ectopics if it might help to search & see that you are not alone & find out how others have managed.
Wx
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@wrensong I also have a thyroid condition and recent tests show my TSH has went up to 2.76 (it normally sits around 1) FT4 at 16 and my FT3 sitting right at the bottom at 3.4. This is on 100 of levo. I did start a trial dose of t3 (10 in the morning) on the back of these results (April) but its made no difference whatsoever and the last few weeks have been really particularly bad of feeling generally rotten so getting thyroid and hormone tests on Friday. I think I need an increase of something somewhere!
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Hi Moog77, I'm sorry you are having probs with your thyroid stability. Quite a few of us on here have a thyroid condition alongside menopause symptoms & it can be a v tricky combination :(. We have a thread called thyroid issues & support I'll bump for you in case you haven't seen it.
Wx
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Moog, what are the ranges for those labs?
TSH of 2.76 isn't awful.
I'm on thyroid meds now but think I need to come off them. I'm on 50mcg T4 and 45mcg T3. I went on them due to debilitating night time symptoms and insomnia which was life-altering. My T3 was on the low side like yours but in range - and I had high rT3. T4 was decent and TSH always alround 1, although once it was 3.5
Anyway, the thyroid meds haven't changed the night time symptoms. Increasing estrogen has helped those although they are not perfect yet but live-able with now.
I think intermittent fasting and erratic eating was causing my low thyroid function. I have fixed all this by eating consistently, 3 meals a day, loads of protein, loads of veg - and doing a reverse diet up to 2200 calories. (I had got stuck where I couldn't eat more than 1200 or less calories a day because my body had adapted to this low level of calories.) Anyway, I've fixed all that by gradually increasing my calories 100 every 2 weeks and tracking absolutely everything I eat on My Fitness Pal.
So next I have to try coming off thyroid meds, which I'm not looking forwards to...
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Joziel ranges are as follows:
TSH 2.72 mIU/L (.27 - 4.2) 62.3%
Free T4 (fT4) 15.9 pmol/L (12 - 22) 39.0%
Free T3 (fT3) 3.4 pmol/L (3.1 - 6.8 ) 8.1%
On 100 of Levo they arent great and certainly enough to feel off. I tend to feel better at at TSH around 1 and with FT4 higher.
Funnily enough i tend to be quite erratic with eating too but its not deliberate Im just not very organised. I need to make sure I am eating 3 meals a day.It definitely makes me feel better.
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So looking at those labs, your T3 is the most important active thyroid hormone. Your body should convert T4 into T3 (although some people convert better than others).
Your T4 (which comes from your levo you are taking) is only 15.9, which really isn't high in that range. You should be able to ask for an increase in your levo. That will give you higher T4 - which hopefully your body will convert to more T3. Your doctor should be very happy to increase your levo if you ask and point out that you still have symptoms and that your T4 is not that high in the range. (NICE guidelines say that if you still have symptoms you should be increased.)
If you try increasing the levo and your T4 goes higher but your T3 doesn't really change, you might need some T3 directly. That will be very hard to get on the NHS. But an increase in levo should be easy.
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I dont convert well and FT3 stays around 4.5 even on a higher levo dose - however that was pre HRT so maybe it might be different now I dont know. I started a small dose of T3 after those bloods but suspect it needs raised. I definitely need more levo though. Bloods taken today to see where I am at now but suspect FT4 might even have dropped lower.
I wish it was easy to get a levo bump but as long as I am in range then my GP is reluctant so probably need to go back private again for that (deep sigh).
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I highly recommend Dr Momi at Functional Thyroid Care if you want to go private. He does online consults and is happy to prescribe T3. He does not go by TSH but by your other thyroid labs. And he's really nice and friendly and kind.
Levo is actually really cheap privately. I think about 3 months of levo costs me £19. T3 is more expensive.
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Hi Joziel
I think intermittent fasting and erratic eating was causing my low thyroid function. I have fixed all this by eating consistently, 3 meals a day, loads of protein, loads of veg - and doing a reverse diet up to 2200 calories. (I had got stuck where I couldn't eat more than 1200 or less calories a day because my body had adapted to this low level of calories.) Anyway, I've fixed all that by gradually increasing my calories 100 every 2 weeks
I'm relieved to see you've turned a corner by increasing calories. As we'd talked about the importance of getting enough calories for thyroid health on the thyroid issues thread (& probably on other threads) some time ago, the dieting history you mentioned there was why I was concerned about your trialling T3 with no evidence of thyroid disease (by which I mean from memory your antibodies were fine), but more what seemed a metabolic adaptation. As you know, sometimes thyroid hormone production is reduced to protect the body in a perceived starvation state & I often worry that if women feel pressure to lose weight via extreme low calorie diets, they may be unaware of how this can skew thyroid levels & give a misleading picture. I hope you're now on the right track & with support coming off thyroid meds, that you'll find your body reverts to producing adequate levels of thyroid hormones for you. This must have been a difficult situation for you & I think you deserve credit for turning it around. :hug:
Sorry this has continued to go off topic, but sometimes it feels important to deal with a serious matter where it arises.
Wx
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Thanks Wrensong. I haven't been trying to lose weight, I'm a normal BMI and happy there. But in the past, if I ate any more, I gained weight. So I was stuck eating about 1200 calories a day and didn't know how to get out of it.
I found this great podcast (which others might want to check out) called Metabolism and Menopause. It has details on how to do a reverse diet. With a reverse diet, you figure out your current maintenance amount of calories (what you can eat without gaining or losing weight) and then you eat that consistently every day. Then you increase by 100 calories every 2 weeks. It is such a small increase that your body doesn't 'notice' that you increased and you don't gain weight. (You might gain a small amount over the entire reverse diet but not much.)
So I've been doing that and I'm now up to 1800-1900 calories. I haven't gained any weight, in fact I lost 3lbs when I first started because I began a bit too low - my metabolism sped up as soon as I started to eat regularly and I didn't increase until I was due to... I only weigh myself once a week because it's just one metric.
I'm also doing strength workouts about 3-4x a week using the Caroline Girvan app (highly recommend) and I'm eating about 120-150g of protein a day.
When I fold my arms, my biceps surprise me. My glutes are now a little shelf.... So... even if I do gain weight, it is highly likely muscle now.
So the plan really is to increase like this up to 2200 calories - which is where I should be - and then to come off thyroid meds. Exactly how to do that (fast, slowly, T3 first and then T4 or both together) and whether I should temporarily cut calories whilst I do, I'm still figuring out...
With the thyroid meds, I do think that taking a very low amount of T3 only (15mcg) worked well for me and boosted my own T3 without suppressing my TSH. But my stupid doctor (who is supposed to be an online thyroid specialist - this is not Dr Momi, it was who I saw before him) freaked out because that low amount of T3 sent my T4 below range. So then she insisted I also take 50mcg T4 and convinced me that this was highly likely the cause of my insomnia and awful night time symptoms (that were destroying my life). So of course I took it. And that (along with the 15mcg T3) was enough to suppress my TSH and make me need a full replacement dose.
I just hope my own thyroid comes back online fine and that whatever this miracle is which is letting me eat so much every day continues, even when I am off thyroid meds.
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Joziel
I think I know the doctor you are referring to before you spoke to Dr Momi...I looked to go there a while back but just wasn't convinced by her at all so cancelled appt. T3 can absolutely reduce FT4 levels and how she didn't know this is concerning for an expert.
I have a private GP who offers prescribing service for a relatively inexpensive fee for a thyroid consultation so will revert back to her for more levo. She too doesn't really pay too much attention to TSH but the ft4 and ft3. Apparently if you are on thyroid meds and start HRT you will likely need an increase and I suspect that's what's happening with me. Definitely a levo bump and more than likely more t3.
I have Dr Momi in my back pocket should I not get a resolution with the private GP but she is refreshingly forward thinking and understands that TSH is not necessarily a good marker to gauge if you are sufficiently medicated. Really a bit of a find to consult with something who understands this.
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That sounds good, having a supportive doctor is so important/essential.
Yes the doctor I was first seeing was a Dr C..... Her whole thing is thyroid stuff. But the thing about the thyroid is there are so many ways it can play up and manifest and sometimes doctors just know the main/core stuff about it all and not much about the more complex cases.
I'm trying to be positive about it all and getting off meds but it would have been much easier if my TSH hadn't been suppressed.
These were my results on no meds at all, with a quite low T3 and a high rT3:
TSH 1.37 (0.270-4.2)
free T3 3.9 (3.1-6.8)
free T4 18.6 (12-22)
rT3 32 (8-31)
Then just 15mcg of T3 did this - sent my T4 below range, but did not suppress TSH, boosted my T3 and got my rT3 right down:
TSH 1.15
free T3 4.3 (3.1-6.8)
free T4 9.7 (12-22)
Total T4 54 (59-154)
rT3 15 (8-31)
Then she made me add in 50mcg T4 and boom...
TSH 0.026 (0.270-4.2)
free T3 5.1 (3.1-6.8)
free T4 13.8 (12-22)
rT3 20 (8-31)
After that, I ended up increasing the T3 because I still had the night time symptoms (which were never anything to do with thyroid, but were hormone related) and my metabolism was really slow (because I wasn't eating consistently and enough - but I thought that could be caused by thyroid). So I'm now on 45mcg T3 along with the 50mcg T4.
I have to figure out how to best get off now.
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Yes Dr C.
I'm quite shocked you were given any thyroid meds with those initial numbers. I personally don't hold much weight in RT3 myself - just my opinion! - it may have been wiser for Dr to ask you to retest in 3 months time but I totally understand that if you are feeling awful then you are desperate for any possible resolution - it can feel quite lonely.
I think if there is no underlying thyroid condition you should bounce back. I guess it's the in-between part now to stopping the meds and best way to do it.
It's weird the t3 didn't suppress your TSH but T4 did.....but everyone's different and when you throw HRT in there well it can get very complicated. I absolutely need more levo and wish I'd pushed for that instead of jumping on the option to get T3. Sometimes - and I'm being a wee bit cynical perhaps - I wonder if it's the better money spinner. That's maybe a bit cruel but I'm so fed up just now I'm viewing everything quite negatively.
What I do know is when I was 3 pumps of green oestrogel and 100 levo last summer I felt great and I suspect all the faffing I have done - with gel to patch due to the outrageous gel bottle issues and now on to sandrena - hasn't helped but I've now been on HRT long enough for Thyroid meds to be affected. So hopefully a levo increase is the answer. I'm not sure I even need T3 but will see.
Hope you get the answers for reducing meds. It sounds like you don't need them after all. Hormones are such a pain. I'm finding this out with testosterone just now as well. It helps so many but for me personally have found it makes me really poorly.
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Yes, I know. My initial thyroid numbers just showed a conversion issue. This was probably caused by my very erratic eating and crap diet. The clue here is that I actually did a test about 3 months before that first test, so also not on any meds, which was:
TSH 3.16
free T3 4.92 (3.1-6.8)
free T4 16 (12-22)
This test was done during a very strange week when I was on holiday with my partner. Because we were on holiday, I was eating regularly. We were still in the UK, so at the end of the week, I did the bloods and posted them to Medichecks. The interesting thing is my T3 is much higher. rT3 wasn't tested. But I think the thing to focus on, is getting T3 up and rT3 will look after itself. If T3 is high/decent, rT3 is not likely to be high or to be causing problems. My TSH is on the high side but it looks like my body was demanding more thyroid hormones and my T3 had gone up accordingly.
Despite also having this test, I was still prescribed T3. I don't mind being prescribed the micro top up dose of 15mcg - but suppressing my TSH and giving me the 50mcg of T4 was just wrong. She was so convinced this was the cause of my night time symptoms. I haven't been back to her since, I lost all faith and switched to Dr Momi.
I was already on HRT before all this but I have increased doses a lot whilst being on thyroid meds (of HRT).
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The impact of HRT on thyroid meds is really important and I'd bet my house that my GP would not be aware of it if I was to see her.
I find that quite scary. How many are struggling because of this?
Such a balancing act.