HRT and hypothyroidism

[sobs1962]

Just wondering is anyone on here is on HRT and what effect, if any it's had on the absorption of Levothyroxine and/or it's effect on thyroid function. Have been prescribed Evorel Conti, a combined HRT patch but haven't started using them yet, any advice or words of wisdom, most welcome.

[radd]

sobs1962,

I was on HRT Oestrogel & Utrogestan and had no problems at all. Whether patch, gel or pessary the thought is it will interact less with thyroid hormone levels as bypasses the liver.

However, I have noticed some members say they have needed an increase in thyroid meds after taking HRT and realistically even if bypassing the liver there could still be a certain amount that circulating in the blood stream will encourage those higher levels of SHBG, and it is this that binds & disables a small proportion of thyroid hormone for some.

I also thinks it depends upon liver function and have found supplementing milk thistle to be hugely beneficial.

[lola1956]

Hello I recently started HRT with the Newson clinic , I started off on the patches but combination of oestrogen and progesterone for me was no good and I was overwhelmed after 36 hours by crying and anxiety, now I’m on Oestrogel and testosterone and in around 6 or 7 weeks will take progesterone tablets vaginal I’ve discovered that I may need to slightly increase my dose of liothyrine as I’m starting to feel very cold inside and generally unwell yesterday!

But I feel oestrogel will in combination with the others , really help me feel more like me again!

I would say keep an eye on it all , your on levothyroxine so others on it may have a better idea but I’m determined to feel well and we should persevere if we can ! Good luck on HRT journey and fingers crossed that your thyroid medication is not affected by it all 😊

[Mino40 in reply to lola1956]

I should mention that I am in tablets.

[rachelleigh in reply to lola1956]

Hi Lola - I would love to find out more about the vaginal progesterone you are taking please. I was only offered the Mirena coil or oral progesterone - with the coil being recommended by my gp. Many thanks!

[Carriebaby]

I was on HRT for 4 months and came off it recently as I put on lots of weight . My breasts went up to cup sizes and were constantly very sore. So I’m now back to the drawing board 😫

[sobs1962 in reply to Carriebaby]

Sorry to hear that, it's such a lottery trying to stabilise hormones.

[dizzy864]

I was put on several herbal forms then prescriptions. The last one vagifem - told I would absorb it better. I was prescribed it as I was told my lack of oestrogen was blocking absorption of liothyronine. I was many years post menopause and had never had a problem before. It completely blocked levo absorption. My hair fell out in clumps! I was really hypo and very ill.I had googled hrt and lio. I found no connection. It never occurred to me that it would affect levo. It was terrible for me.

[posthinking01 in reply to dizzy864]

I went on HRT in 1986 - had hysterectomy in 1983 aged just 33 years of age - I was taking the tablets in those days - it completely changed my life having really suffered after the operation even though my ovaries were left. It saved me I have never felt so well - but...........aged 50 when menopause kicked in - the HRT caused an issue as the adrenal glands were under pressure due to need to supply energy for a thyroid issue I did not know I had a that time. Whilst I know I need it - unfortunately I had to come off it completely as I cannot seem to get it through the body in the correct way - i.e. metabolic issues due to thyroid. For information I felt very very well on the pill as well and when pregnant - so looks like the sex hormones were involved somewhere as the adrenals produce progesterone - a bit of oestrogen etc. etc. so problem somewhere - i.e. adrenals were not producing what they should - now on steroids for adrenal insufficiency so was probably right. Now when I take HRT gel I swell up alarmingly.

[Pastille in reply to dizzy864]

That's awful having to go through that and having no idea why! It really should be mentioned more

[Hidden]

It’s well documented that transdermal HRT in the form of patches or gels has only a slight effect if any

[sobs1962 in reply to Hidden]

I hope you're right about that as have vulvar skin conditions to cope with and don't want having to wear sanitary protection to make the whole situation worse.

[Hidden in reply to sobs1962]

We are talking about different hormone medications. I’m referring to systemic transdermal hormones such as patches and gel.

I think you’re referring to Vagifem or other topical pessaries.

[sobs1962 in reply to Hidden]

I have been prescribed Evorel Conti Patches, but yes have used vagifem pessaries, my main concern is vaginal bleeding as don't think I could use either pads or tampons if that happens, as have vaginal atrophy and lichen sclerosus and lichen simplex chronicus too. I'm beginning to regret agreeing to HRT, but the psychological effects of menopause have been so bad for me as a person with a long history of mental illness.

[Hidden in reply to sobs1962]

Im sorry if I’m being dense Sobs but are you associating vaginal bleeding with HRT?

[sobs1962 in reply to Hidden]

Yes, as apparently according to the patient information leaflet vaginal bleeding is a commonly side effect, but usually stops after a few months.

[Juliehypo in reply to sobs1962]

Hello . I’m using an estrogen topical cream called Estradiol. It bypasses the liver. I just apply on arms or back. I had a hysterectomy at 37 ovaries removed as well. Sorry you’re having such a hard time.

[Starfish123 in reply to sobs1962]

For vaginal atrophy try taking a supplement of sea buckthorn oil supplement. I also have this but because I take the sea buckthorn oil it goes away, highly recommend it.

[radd in reply to sobs1962]

sobs1962,

Evorel Conti patches contains forms of both oestrogen & progesterone. Therefore, you should continue having periods which are required to reduce the risk of womb cancer.

You can only take oestrogen-only HRT if you have had your womb removed during a hysterectomy.

[sobs1962 in reply to radd]

So, what you're saying is I'm going to go back to having periods after over 5 years without them, got to say I'm not looking forward to that especially as I have lichen sclerosus, lichen simplex chronicus and vaginal atrophy and having to use towels or tampons could make these other conditions so much worse.

[radd in reply to sobs1962]

Yes.

Sorry to hear of all these conditions 😔

[sobs1962 in reply to radd]

Well, what can I do, I guess some of us are just extremely unlucky or maybe it's a case of you get what you deserve in life.

[Farrugia in reply to sobs1962]

I don't think Evorel Conti will make you go back to having periods. (I'm not a doctor just talking from personal experience). I think you need to take progesterone to protect your womb if you still have one but if your periods have finished then I don't think it will make them start again other than maybe a little breakthrough bleeding. I have been on HRT for several years and have tried a lot of different forms.I've never had any breakthrough bleeding even though I've been warned by the doctor about it every time I change the type of HRT I'm taking. I now use Estradot patches for oestrogen and I take Utrogestan tablets for progesterone (incidentally my sleep has improved massively since taking these). These are both body -identical forms. I've tried Evorel Conti and didn't have any bleeding with that. I also have LS and I understand your worries but if anything HRT has helped my LS symptoms. I also use vagifem and am prescribed Dermovate for the LS. I was already taking HRT when I started Levothyroxine for Hashimoto's so I don't know what happens if you're already on Levothyroxine and start HRT. I'm always careful to take any oral HRT well away from levothyroxine. I take the Utrogestan at night because it helps with sleep.

I hope whatever you decide to do that you find something that works for you. I find it can be quite tricky to work out what is a menopausal symptom and what is a Hashimoto's symptom, I'm not sure I'm optimally medicated for either but I'm a lot better than I was before. Good luck.

[sobs1962 in reply to Farrugia]

Thanks for that, starting with the patches today, so fingers crossed it doesn't make me an emotional wreck as,my mental health is severe enough and I'm not sleeping and that makes everything so much worse. Your story gives me some hope.

[Farrugia in reply to sobs1962]

I hope the patches help. I definitely feel much better mentally as well as physically since taking HRT. I found this article on the balance-menopause website, there are loads of other articles on there but given how you are feeling I thought this one might help. balance-menopause.com/menop...

[sobs1962 in reply to Farrugia]

That's encouraging to read, put my first patch today, well the first one wouldn't stick so had to use another, so we'll see how I get on in the next few weeks.

[Catseyes235 in reply to sobs1962]

HRT helps with Vaginal dryness.

[SarahJane1471]

I started on estrogen patches 5 years ago. I have no womb so only need estrogen. 3 yrs later I started suffering hypo symptoms. So since July began the Levo regime. I think that HRT caused me to become Hypo 🤷‍♀️. I read it somewhere when I was investigating my hypo symptoms. I may have got that very wrong and I’m happy to be corrected 😁.

[Hidden in reply to SarahJane1471]

I think that matter is still under discussion. Transdermal sex hormones are far less likely to affect thyroid.

This supports my point about the wording of assertions. I had oestrogen patches when they were a new innovation and said not to cause breast cancer. They did.

There is very little research which gives an outcome which is definite

[Juliehypo in reply to SarahJane1471]

I believe estrogen caused my hypothyroid as well after my hysterectomy at 37 but I could be wrong

[Hidden in reply to Juliehypo]

This is the problem I have with studies, research, opinions et. They can all be wrong.

The weakest area is drug interactions. I have four favourite sources and it isn’t unusual to find conflicting information in each.

For reliable information about pharmaceuticals, I find that pharmacists are the best source.

[Juliehypo in reply to Hidden]

Agreed

[Astridnova]

Thyroid problems are said to be three times as common post hysterectomy in dogs, and those dogs lack oestrogen, of course. My mother, who had a hysterectomy in her 40's, showed obvious hypothyroid signs (weight increase, no energy, slowness) in her 70s. These went away when she went on HRT in her late 70s. She became slim, lively, and designed and conducted a six-week course in adult French. When the breast cancer scare happened a few years later, she went off the HRT. Very soon she began to have gross signs of hypothyroidism. Unfortunately this was not diagnosed until too late, and then only treated ineffectively, until myxodema ensued. After I had a hysterectomy, I started to show signs of hypothyroidism, which were not diagnosed. I went on HRT, however, and the hypothyroidism improved. However, it came back over about ten years, until it was diagnosed and treated with NDT. My doctor thinks that oestrogen helps thyroid metabolism and I think so too, based on the above anecdoctal observations.

[Hidden in reply to Astridnova]

I agree and so do many medics. I am a BC Survivor and have just gone back onto HRT

[Gymbuni in reply to Hidden]

I am also a BC survivor and wonder how you managed to get hold of HRT? I have been refused several times. Perhaps your BC was not Er+ Pr+. I am suffering dreadfully with night sweats, hot flushes and vaginal atrophy and nothing seems to help.

[Hidden in reply to Gymbuni]

Hi Gymbunu

I was dx 10 years ago wirh BC ER+ after 10 years of transdermal HRT following a total hysterectomy (incl ovaries) 10 years before age.

Just as they were beginning to organise radiotherapy, they found a huge thyroid cancer and that was removed with thyroid while they were completing the treatment for BC.

I’ve felt like a dead duck ever since with the same symptoms as those you describe above plus joint and muscle pain and fatigue. I put this down to the thyroidectomy and less than optimal medication.

A couple of months ago I was speaking to my BC nurse who suggested that these could be symptoms of low oestrogen. I’ve had no natural oestrogen since I was 47. Oncologist wrote a letter to GP. He was a bit hesitant but HRT after BC is now quite popular and indicated in the NICE Guidleines. He gave me Sandrena gel which is safer. I’ve got to see a menopause Gynaecologist in two weeks.

To be honest, at the small dose I’m on I feel no different. I won’t risk an increased dose. I’ll see what they say at the Menopause Clinic.

[Gymbuni in reply to Hidden]

Thanks MorecambeBay for your reply, I also have the joint and muscle pain and fatigue, but it is the sweats that get me down the most. My BC diagnosis was 7 years ago and I am no longer under the BC consultant as was discharged after 5 years, I feel my risk is low as I had a double mastectomy and it hadn’t spread to my lymph nodes. I will try getting another referral to the menopause clinic and see if they view things differently now to 4 years ago when I was seen and fobbed off with clonidine then anti-depressants (neither which worked).

I can understand how you won’t want an increased dose of HRT if it was HRT that caused your BC, it is so hard balancing up the risks against the quality of life.

I have not long started on T3 and for a short time the sweats improved which I put down to the T3, but the sweats seem to be coming back now, the short term relief for 2 weeks was lovely. I think 8 need progesterone, I suspect I am oestrogen dominant, though I have had this tested.

I hope you get a good outcome from your upcoming menopause appointment.

[Hidden in reply to Gymbuni]

Thank you - and good luck to you 😉

[helen_m]

Hi, I had been on transdermal patches (evorel conti then another one that I couldn't get due to brexit, Fem 7) for years. I'm on levothyroxine/liothyronine combination. I did find that I needed an increase of 25mcg levothyroxine. I'm now on Utrogestan and Eostrogel due to issues with patches supply, the only one that seems to be available is Evorel Conti patches and unfortunately they make me bleed.

[sobs1962 in reply to helen_m]

That is one of the things that worries me as I have lichen sclerosus and cannot wear pads as they cause terrible irritation and don't know if I could use tampons as also have vaginal atrophy and haven't needed any form of sanitary protection for over 5 years. Have vagifem pessaries for the vaginal atrophy but wouldn't want to use them as well as the Evorel Conti as would probably be too much oestrogen. Obviously don't know if they will cause bleeding, as haven't started using them yet, but don't want my vulvar skin conditions made worse.

[helen_m in reply to sobs1962]

I guess give it a try for 3 months? It may not have the same effect in everybody. I definitely needed the HRT though, I tried to come off it once I hit 50 but the menopause symptoms were really bad. It's so difficult to find a balance. Good luck with it all

[sobs1962 in reply to helen_m]

Thanks for that, we women, have to suffer so much crap, it's just so unfair.

[Farrugia in reply to sobs1962]

Apparently the vagifem dose is very small, something like 1 year's use of vagifem is equal to one dose of oral oestrogen. This means you can still take vagifem if you take other forms of HRT. Have you looked at the Balance-Menopause website from Dr Louise Newson? Lots of info on that.

[Rlfan in reply to sobs1962]

I had terrible vaginal atrophy with soreness, thinning of the skin, lack of lubrication and after 4 weeks of Vagifem is started to get better and now is back to normal, very plump. I now am on Evorel patches as well - just gone up to 75, oestrogen only as I have no womb and am very well. I haven’t had any changes to my thyroid symptoms since starting HRT either. Dr Louise Newson, on her Balance website, says it is ok to use Vagifem and patches together. Good luck with your treatment, I do hope you get some relief soon.

[sobs1962 in reply to Rlfan]

Have the balance app on my phone now and was using vagifem pessaries earlier this year but female doctor advised to use 3 months on 3 months off regime, but haven't used since May this year, only started on Evorel Conti so might be better to see how that goes first before using vagifem again but as I have now been diagnosed with Lichen sclerosus and Lichen simplex chronicus, I have to be very careful with what comes into contact with my vulva as this is the area which is affected by these autoimmune skin conditions and using vagifem pessaries produces vaginal discharge which I don't normally have and it can cause more irritation, it's all a nightmare to be honest, but just have to keep soldiering on and hope things improve.

[sobs1962 in reply to helen_m]

Well, unfortunately unless my TSH goes over range, I can't see my doctor increasing my levo as they don't even test t3 and that's the most important indicator of thyroid function. Suppose I will just have to wait and see what happens, but don't want to go back to feeling horrendous again if it can be helped.

[Hidden in reply to helen_m]

I’m on Sandrena Gel. Can you get Fem Seven. I found that very good

[BadHare]

If the one you've been prescribed doesn't work effectively ask for a different one to see if that suits you better. Some, such as those made from horse urine. I'm avoiding any containing norethisterone due to side effects. I was happily taking a synthetic for years which has been withdrawn, & the replacement less effective. I didn't do well well on bio-identical HRT. One thing I picked up early was to ensure I take it away from NDT/T3, & vitamin D for efficacy.

[sobs1962 in reply to BadHare]

My vitamin d levels are way over range so will stop taking for a few weeks, but as the patch stays in place and is releasing the hormones constantly, how can I avoid it affecting my Levothyroxine?

[BadHare in reply to sobs1962]

Sorrry, I’m not sure it’s an issue with transdermal patches as taking oral HRT, but I’m guessing.

[Batty1]

Ive been on HRT for 17 years (hysterectomy) and I make sure to take it 4 hours away from my thyroid meds and haven’t had any issues.

[sobs1962 in reply to Batty1]

I can't take it 4 hours away from my thyroid meds as is a transdermal patch that is constantly releasing the hormones, however I suppose I just have to try it and see what happens but also worried it may make me very anxious and tearful and as someone who has severe depression and anxiety, that's the last thing I need.

[Batty1 in reply to sobs1962]

I started out on the patches and discontinued due to my skin condition and have been taking estradiol pills ever since…. I don’t think their is a one size fits all.

[sobs1962 in reply to Batty1]

You're right, but I'm never going to know if I don't try at least.

[milkwoman]

I’m on custom compounded transdermal HRT and I have had to increase my thyroid meds to be optimal. Just my experience. When my HRT and thyroid hormones are balanced I’m able to maintain my weight/figure. I also exercise regularly and eat fairly well (everything in moderation).

[SarahJane1471]

I think if anyone wants to get the best information then Google Dr Louise Newsom. She states there is no increased risk of breast cancer with HRT. 🤷‍♀️The research that scared everyone 20 yrs ago regarding this has since been disproved. In fact the health benefits far outweigh any risks.

[Mino40]

I had a total hysterectomy, I am in oestrogen only. No side effects and it doesn’t appear to affect my hypothyroidism. I feel amazing on the HRT.

[Catseyes235]

Was on HRT 10 years with no problem. (42-52) Coincidentally when I stopped taking it was when I seemed to stop converting T4 efficiently (v low TSH results) but think that was just age and now on T3 supplement. The thyroid is so complex it’s going to take a long time to unravel the interactions. I really feel symptoms are so important over test results.

[sobs1962 in reply to Catseyes235]

Yes, and that's the problem, doctors seem to be only interested in test results and ranges and if you're miniscule amount inside the range it's classed as "normal", they're taught to diagnose by symptoms but in practice they don't do that and we the patients suffer as a result.