Menopause: how to know if your symptoms are thyroid-related or not?

It's been six weeks since my last period and no signs of it coming back.

My gynaecologist prescribed Femoston 2/10 for me, saying that oral hormones are better absorbed by the body than transdermal estrogen (I was on Estrogel until recently).

It's only my fifth day on Femoston, and I've read that it may take up to a couple of weeks to feel its full effects as oral estrogen needs to be metabolised by the liver but, so far, I'm suffering terrible hot flushes and night sweats. I never sleep more than a consecutive hour or two during the night, and I think I woke up eight times last night. I often wake up around 3 am and then toss and turn until it's time to get up, and both me and the bedlinen are drenched in sweat. This is beginning to take a toll on my physical and mental well-being.

I've been on the same dosage of Thyroid-S for several years, but all doctors except my hormone doctor claim I'm overmedicated as my TSH is suppressed...however, my FT4 levels are midrange and my FT3 levels at top of range, but not over range.

My question is: if you are indeed suffering from drug-induced hyperthyroidism, would you not tend to sweat all day long, and not mainly at night? Isn't that typical of menopause?

If anyone else has tried both oral and transdermal estrogen, I'd appreciate to hear about your experiences...which one did you prefer and why? The Hertoghe doctors (I'm seeing one of them) only work with transdermal estrogen as they claim oral estrogen is hard on the liver, but my gynaecologist suggested we try Femoston and I thought "why not?" as Estrogel has not been working optimally lately...but maybe that is because I am only supposed to use Estrogel day 5-25 of cycle, whereas Femoston is to be taken continually...?

I did not expect menopause to be easy, given my endocrine disease (Hashimoto's), but i never expected it to be this hard...especially on HRT.

[SlowDragon Administrator]

Have you had vitamin D, folate, ferritin and B12 tested recently

Low B12 can cause night sweats

[Hidden in reply to SlowDragon]

No, it's been almost a year since I saw my hormone doctor and no other doctor ever asks for these tests...but I guess I could add vit B12 without problems as it's water soluble and see if it makes a difference? Probably vit D as well as we usually have vit D deficiency in northern Europe, especially during winter months...?

Would it be best to go for a vit B12 only supplement, or one containing all vits B?

[SlowDragon Administrator in reply to Hidden]

Best to test first really. Are you in UK?

Private tests are available, thousands on here use these

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

All thyroid tests should ideally be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, and T3 12 hours prior to test, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)

If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all hypothyroidism in Uk is due to Hashimoto's

[Hidden]

No, Belgium.

[SlowDragon Administrator in reply to Hidden]

Lots of thyroid and hormone specialists in Belgium (Dr Hertoge)

As you have Hashimoto's are you on strictly gluten free diet?

[Hidden in reply to SlowDragon]

No. I’ve never been so I doubt it’s related to my recent problems.

[SlowDragon Administrator in reply to Hidden]

If you have Hashimoto's and are not on strictly gluten free diet it's more likely vitamins are low.

Leaky gut is common and helping to heal gut by gluten and/or dairy free diet can often help vitamins improve

The longer we are under medicated or have gut issues the lower vitamins can get.

Vitamin D is not a vitamin but a pre-steroid hormone.

B12 is important for supporting hormones

hormonesmatter.com/are-you-...

womensinternational.com/por...

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

drmyhill.co.uk/wiki/hypochl...

Low vitamin levels can affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's is very poorly understood

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

Ideally ask GP for coeliac blood test first

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

amymyersmd.com/2017/02/3-im...

chriskresser.com/the-gluten...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

thyroidpharmacist.com/artic...

[samaja]

I hope your doctor has also highlighted the fact that oral hormones might increase the risk of strokes and heart problems while the transdermal application is safe. And I wonder where your progesterone is in all this? Are you sure you don't actually have estrogen dominance?

Unfortunately thyroid and menopause problems often go hand in hand but most doctors (at least in Britain) don't really know how to manage either and definitely not both of them together.

[Hidden in reply to samaja]

Femoston 2/10 contains both hormones (estradiol and dydrogesterone; you take estradiol only for 14 days and dydrogesterone + estradiol for 14 days).

No, the doctor who prescribed Femoston hasn't mentioned the risks but I've read about them and don't feel too tempted to try Femoston...

I think estrogen dominance is more likely in younger women (mid-30s to early 40s), not in someone approaching 50..my symptoms are more indicative of estrogen deficiency than dominance.

I agree with what you say about doctors often being unable to deal with one hormonal deficiency, not to mention two...!

[samaja]

I don't know Femoston specifically but it sounds like you are on synthethic hormones which means that you are on progestins not progesterone. i was on them in the past and they did not do much for me while now I am on bioidentical hormones and specifically on real progesterone and that solved the hot flushes (every hour day and night) and most of insomnia problem really fast.

I can also assure you that estrogen dominance is likely in any woman irrespective of age because it does not depend on the total amount of estrogen you have but on the ratio of estrogen to progesterone and even with low estrogen I developed ED because I had even less progesterone and that was after I had started BHRT!

[Hidden in reply to samaja]

Interesting, thanks for your feedback and input!

[Hidden in reply to samaja]

It seems Femoston contains bio-identical hormones, and I have found several articles describing dydrogesterone (the progesterone in Femonston) as being just as safe as Utrogestan. So I guess the problem is more related to oral estrogen, and the fact that it needs to be metabolised by the liver, whereas transdermal estrogen enters the bloodstream directly.

The warning that using HRT for more than five years increases the risk of breast cancer and possibly other forms of cancer as well, does that apply only to synthetic hormones, or to bio-identical hormones as well? I have been trying to find an answer to that question but it turned out not to be so easy...often, the word "hormones" is used, and it's impossible to tell whether it refers to all hormones or just synthetic hormones...

I have read an excellent book called "Female brain gone insane" written by a midwife working with bio-identical HRT, and it seems to limit the risk to synthetic hormones...but I just wanted to make sure.

[Hidden in reply to samaja]

You could actually be right about the estrogen dominance...I have almost every symptom in this list:

restartmed.com/estrogen-dom...

I've been especially concerned about hair loss which has not been this bad since before I was diagnosed with Hashi's in 2000...

My gynaecologist told me that, given my age (49), estrogen would be needed...

All I'm wondering now is if estrogen dominance can cause intense night sweats as that is my most recent symptom and the most debilitating one...?