Levothyroxine & the Menstrual Cycle

[Jane_Scribbler]

I'm relatively new here and I was wondering whether there has been any research into adjusting levels of medication in relation to menstrual hormonal fluctuations? Are the differences between male and female bodies considered when Levothyroxine is manufactured and tested? I'm sure thyroid hormones interact with menstrual cycle hormones, which is why it's common for many of us to have worse PMT than women without a thyroid condition. I recently had a prescription that didn't suit me and my TSH went above range. Whilst under medicated, I felt similar to how I usually feel 1-2 weeks before my period, which leads me to think I need greater amounts of thyroid hormone in the days leading up to my cycle.

[Jazzw]

There has. Here’s one: ncbi.nlm.nih.gov/pmc/articl... A quick Google would probably find others.

Thyroid hormones in a healthy person do go up and down during the course of a menstrual cycle. There are some interesting variations which appear to be linked to body weight.

But I think it wouldn’t be easy to adjust the dosage of levothyroxine (or other thyroid hormone replacement) in accordance with your cycle, if that’s what you’re wondering. The dosages aren’t precise enough for that kind of titration.

[Jane_Scribbler in reply to Jazzw]

Thanks for your reply and for sharing that study - I'm trying to get my head around it! Yes, I think you're right about levothyroxine.

[birkie in reply to Jazzw]

Hi jazzw❤️

Hope you don't mind me butting in on your conversation and it was interesting to read the link to🤔 do you think thyroid medication can affect menupause? I found that T4 ramped up my menupausal symptoms I came off it and my menupausal symptoms went back to normal, I only get a flush a small sensation of heat slight upper lip sweat but this went in to overdrive on T4. I'm now back on T3 after a silly endo asked me to try T4 again.... Wish I'd never listened to him... T3 seems to highten the menupause symptoms but not as bad as T4🤔 I have no thiyroid or womb/cervix and can't take HRT.. Due to clotting of my blood.. 😭

[Smash49]

Hi there. I don't know of any studies only personal experience. I have always had problems with my menstrual cycle because I have PCOS. However once I started taking Levothyroxine I developed Pre Menstrual Dysphoric Disorder which went undiagnosed for years and made my life unbearable. I know it was levo that caused it because when I stopped taking it the symptoms went away. I definitely believe there is a connection. I did find that following a low GL diet helped a little with premenstrual symptoms but not very much as did excluding caffeine from my diet. I think there will be many women who have the same problem as yourself. The main advice I would give is to seek help if your PMS starts to ruin your life as there is help out there its just hard to find doctors other than a few gynae consultants who will recognise it. PMDD is also recognised in mental health circles and is mentioned on Mind's website.

[Jane_Scribbler in reply to Smash49]

Hi Smash49, thanks for your reply. Sorry to hear about what you have been through. I know all about PMDD unfortunately and I was going to Nick Pannay's clinic at Chelsea and Westminster hospital for just over a year. I've tried all of the contraceptive pills, coils and HRT and nothing helped with my symptoms. My plan is to try and get my Hashimoto's condition under control as best I can before trying any of the more drastic PMDD treatments such as injections.

Can I ask, have you stopped taking levothyroxine altogether? Or do you have to take it and put up with the symptoms? Thanks for the dietary tips, I haven't tried the low GL diet. I have given up gluten, soy and caffeine and I've reduced alcohol and sugar intake. Thanks again x

[Smash49 in reply to Jane_Scribbler]

Hi Jane_Scribbler, sorry to hear you've been suffering with PMDD. And it really is suffering. I stopped taking levo about 2 years after first being diagnosed hypothyroid. So this was about 10 years ago. I stopped to prove it was the levo that was causing my symptoms. At the time I didn't know PMDD existed. Stayed off it for about 4 to 5 months and the premenstrual symptoms righted themselves in the first month. However after a couple of months the hypo symptoms returned to a point where I had no choice but to go back on levo and the PMDD returned immediately. Back then I knew that I was different from others who took levo but I only came across thyroid UK a couple of years ago so prior to that due to docs etc I thought it was just me. Probably 3 years ago now I ended up being hours away from ending my life and had a total breakdown due to the PMDD. Fortunately I admitted what I was about to do to my partner and he sorted me getting gynae referral. As by this time I was 49 I was given Zoladex implants 3 monthly and it put me into a medical menopause which I continued till I was 51 1/2.Im now 52 and fingers crossed have remained in menopause which has symptoms of its own but nothing like PMDD. If you are much younger then you could have this treatment for a while but it can't be long term. However some people find that once they stop their menstrual cycle never returns, not great if you want more children. I believe that those women who are not as close to a natural menopause as I was and do not want any more children can have a total hysterectomy ie. removal of ovaries so that your PMDD can't return. You would need HRT though until you reach 50ISH. It's drastic treatment but you have an extremely debilitating condition. For those who haven't heard of it before it is like becoming possessed for 2 weeks out of every month. I can't even say it holds any resemblance to the worst PMS you can imagine because it is so very much worse. Some women are misdiagnosed as bipolar. The basic principal of a low GL diet is probably what you are doing more or less now, cutting out sugar and alcohol, having unrefined carbs, making sure you eat some protein food if you eat fruit so that you keep your blood sugar as stable as you can as a diabetic would. Definitely don't cut out or reduce carbs though in the 2 weeks before your period is due, just make sure they are unrefined. You need the carbohydrate to help with the symptoms during that time. The book I used was The Low GL Diet Cookbook by Patrick Holford. It was recommended by a medical herbalist. If your not looking to lose weight you can adapt any of the recipes but it gives you the basic principal. I also was receiving treatment from a medical herbalist who made up a 'herbal medicine' for me which I also found helped a little. The diet and the medicine helped a little but nowhere near enough. I hope you get some relief in the future. By all means private message me if you want any support or just to chat to someone who knows what PMDD feels like cos only someone who has had it can truly understand. I hope you get it sorted. Best wishes to you

[Jane_Scribbler in reply to Smash49]

Thanks so much for your reply and I'm glad to hear that you no longer have PMDD! It's very interesting to hear that it also went away periodically during the times that you didn't take levo. I don't think I could try that, as I feel so bad when I don't take it. I'm currently seeing a private endo to try and figure out my optimal level and brand of levo. Then my plan is to see a nutritionalist to find out which foods to cut out, as there doesn't seem to be a one size fits all approach - we all vary so much! I will definitely look at that cook book though. Thank you for your supportive words. PMDD has taken it's toll on my career, relationships - I'm sure many people think I'm bipolar! I'm 36, so I'm trying to avoid Zoladex and the hysterectomy routes for as long as I can stand it x

[Smash49 in reply to Jane_Scribbler]

I hope you find a way to control your symptoms so that you can get your life back on track. I've always believed that levo has a detrimental effect on the pituitary gland and hypothalamus which control the reproductive hormones but that's just a personal opinion. I'm just waiting for my referral letter from my GP to see a private endo recommended by a lovely lady on here in the hope of being prescribed T4/T3 combo. Have you considered trying T3 only, or T4/T3 combo to see if it is the T4 treatment only that's causing the PMDD. I definitely wouldn't advocate stopping taking any medication like I did. I only did it to prove it was the. Levo to myself. I think if I had known what I know now thanks to this forum I would probably have tried T3 only to see if that worked as it would mean you would still be treating your hypo but without the Levo. Whatever you decide to do with the help of your endo I wish you the best of luck

[Jane_Scribbler in reply to Smash49]

Thank you. Good luck with your Endo referral. My one went a bit stiff when I dared mention T3 in my first appointment, so it may take a while or I may just need to switch doctors at some stage. All the best x

[Zazbag]

I don't think it's levothyroxine that causes PMS, I think it's hypothyroidism. I had PMDD (which developed and worsened because of and along with my hypothyroidism) until I added liothyronine to my levothyroxine, now it has completely disappeared. Check your FT3. If it's suboptimal, that might be causing your PMS.

[Jane_Scribbler in reply to Zazbag]

Thank you Zazbag, that's great to hear. Although I was secretly hoping I wouldn't need T3, as I know how bloody difficult it is to get hold of. Long road ahead I guess...

[Zazbag in reply to Jane_Scribbler]

You can buy it from the US without prescription. Imo it's not that expensive. I can message you the website if you want to know.

[Jane_Scribbler in reply to Zazbag]

Yes please! Thanks v. Much

[Smash49 in reply to Zazbag]

I've been apprehensive about self medicating because not sure how it would affect life insurance/travel insurance. Having a mortgage and family I wouldn't like to leave them unprovided for if anything ever happened to me god forbid. Does anyone know if your insurances would still pay out if you were self medicating?

[Zazbag in reply to Smash49]

I don't have insurance or a family or a mortgage, I just want to feel like my life is worth living and self-medication is the easiest way of achieving that for me personally.

[Smash49 in reply to Zazbag]

Sorry Zazbag that comment wasn't a personal dig at your decision to self medicate as I would definitely do that if I don't manage to get treatment privatly. It just reminded me that I've often thought about the insurance thing but then I always forget again to put it out there on this forum for comment but you jogged my memory by mentioning self medication so thank you for that. Im really pleased to hear that you've regained your health

[Zazbag in reply to Smash49]

Oh no, don't worry I didn't feel like it was a personal dig, but I appreciate your kind words It's smart to consider things like that, and I'm sure other people on the forum would know better than I do on that topic. I'm really pleased I've got my health back too, you can as well. I hope it happens for you soon! I got too desperate to wait any longer.

[Smash49 in reply to Zazbag]

I agree with that Zazbag. I have the DIO2 gene fault and my T3 is low even when my TSH and T4 are optimal hence awaiting the endo appt. However it wouldn't explain the PMDD resolving when I ceased all thyroid medication as my T3 would have been low then too. All food for thought isn't it

[Zazbag in reply to Smash49]

Apparently, when you take levo it stops your thyroid producing its own thyroid hormones because your brain detects that it doesn't need to. So when you go off levo, it forces your thyroid to kick into gear again. You temporarily start to produce more thyroid normals naturally (including T3). This can make people feel much better in the short term, but a damaged thyroid can't sustain this for long, so after a certain length of time you would start to feel bad again, and worse than when you were on levo. Did you permanently stop taking levo, or did you just stop it for a while and start taking it again?

[Smash49 in reply to Zazbag]

That's really interesting. I stopped for about 4 to 5 months I think, it was so long ago I cant be more accurate. My menstrual problems disappeared for the whole time but after a couple of months the coldness, falling asleep at every opportunity etc returned. Its funny though because the tiredness was different to the fatigue I feel whilst taking levo. It was sleepiness rather than the extreme fatigue I have on medication. As soon as started the meds again the menstrual problem returned. The endo I'm gonna see also has a special interest in PCOS so maybe he may have ideas as to why PMDD surfaces with hypothyroidism. I shall post again if he does come up with anything interesting

[Zazbag in reply to Smash49]

This sounds like an issue with low T3. If you convert poorly then it makes total sense.

[Smash49 in reply to Zazbag]

It's a pity NHS doctors haven't seen things with as much sense isn't it, for all our sakes.

[Zazbag in reply to Smash49]

It's blind ignorance from GPs and institutional gaslighting from the NHS. It's criminal.