One for the ladies 🚺
My gp has prescribed oestrogel and progesterone capsules.
Any interactions/tricks I should know about.
Many many thanks 😊
HRT and levothyroxine : One for the ladies 🚺 My... - Thyroid UK
HRT and levothyroxine
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Bearthebishon
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SlowDragonAdministrator
As you only started levothyroxine a month ago
healthunlocked.com/thyroidu...
…..probably don’t want to confuse the picture yet by adding HRT as taking HRT frequently results in needing higher dose levothyroxine
Presumably you are still only on 50mcg the standard starter dose levothyroxine
Did you change brand levothyroxine or are you taking Teva
Have you had coeliac blood test done yet
Thanks SlowDragon
Just had my first 6 week blood test done and been upped to 75mg. I changed brands to Accord after my post regarding Teva.
How long do you think I should wait before starting HRT do you think?
No I haven't had a coeliac test.
Give levothyroxine increase at least 4-6 weeks to get use to otherwise you won’t know if it’s increase in dose or HRT causing issues
What were recent results after 6 weeks on 50mcg
Serum tsh level 9.00 (0.2-4.2)Serum free t4 14 (11-23)
So likely to need further increase in levothyroxine after next test in 6-8 weeks
So do you suggest that I leave the hrt until my levels are within range?
Personally I would…yes
Guidelines on dose levothyroxine is to increase dose slowly upwards in 25mcg steps until TSH is ALWAYS under 2
Most people when adequately treated will have TSH around or under one
Guidelines on eventual dose levothyroxine by weight is approx 1.6mcg levothyroxine per kilo of your weight
Recommend getting coeliac blood test done as next step
Assuming coeliac test is negative can trial strictly gluten free diet in New Year
Thanks so much for your advice and Merry Christmas 😊
Hello, this is the HRT I take and it works very well. As the estrogen is a gel it is absorbed in a way that (in my experience) has very little a impact on thyroid medication. I started with 1 pump of gel and my symptoms improved very quickly. No more hot flashes and finally sleep! My cognition also improved and my anxiety. As I was unable to differentiate between thyroid and menopausal symptoms so taking the HRT helped me enormously. I read a lot about side effects of the progesterone and there are anumber of ways to take this, and take it (including inserting the capsules vaginally to minimise side effects as seems to be preferred by many private menopause practitioners and yes it works!)
As it can take years to balance thyroid meds I'd take the HRT if you are having symptoms.
SlowDragonAdministrator
Plus get vitamin levels tested too
Vitamin D, folate, ferritin and B12
What vitamin supplements are you currently taking, if any
Immune complete 1 by Cytoplan.
Daily multi vit
We never recommend multivitamins
Most, like this one, includes iodine, not recommended for anyone with autoimmune thyroid disease
Test levels and only supplement what’s necessary
Flipping heck...they weren't cheap either 🤦♀️Is there anything in particular I should be asking the dr to test. They will be sick of me at this rate 😄
Test vitamin D, folate, ferritin and B12
Often need to test privately if GP won’t
Suggest you test thyroid and vitamin levels in 6-8 weeks via Medichecks or Blue horizon
Bearthebishon,
The forum is anti multivitamin combo’s for the reason that we often have much larger deficiencies in particular nutrients than a ready mix can cater for. Also contained within the mix might be unnecessary nutrients we don’t need such as iodine.
We have iodine contained within our thyroid hormone replacement meds, and eating a balanced diet should meet our needs. If you still have your whole/partial thyroid gland it is important not to overload on iodine which can cause unwanted reactions. There is also thought that iron should be taken separate from other nutrients, also magnesium which can bind other nutrients but I am of the opinion this happens when large amounts are involved. After all we don’t separate our foods to aid absorption.
Deficiencies are common in hypothyroidism due to insufficient gastric acid causing impaired absorption, resulting from inadequate thyroid hormones levels. In autoimmune disease there also appears association with genetic impairments that might influence the normal processing of Vit B12/folate or utilising iron or Vit D properly. Hence, these are extremely commonly seen deficiencies on this forum, often requiring large maintenance doses.
However, if we don’t have deficiencies or they are being addressed separately I think a multivitamin can be useful when we are fed up taking copious amounts of pills, even when iodine is involved in minute quantities such as 0.5mg. This combo is a great mix containing a wide variety of good quality vitamins, minerals, micro-nutrients, phytonutrients, etc, including methylated versions but unfortunately it contains 80mg of iodine which is a huge amount for someone already medicating Levothyroxine. The NHS recommended daily adult iodine intake is only 140mg so I really wouldn’t recommend taking this supplement.
Also I'm with SlowDragon about leaving HRT until you are Levothyroxine-optimised and maybe even several weeks/months after that. If you are O & P deficient then eventually taking HRT should help stabilised thyroid hormones to work even more effectively as no hormone works in isolation but will influence or be influenced by many factors/changes in other glands hormone levels. However, symptoms can lag behind good thyroid hormone biochemistry by several months and you need to know/feel what changes Levo is making in order to achieve a sweetspot that isn't totally lab dependant.
Hi there agree with you - it is also worth remembering that oestrogen is a sex hormone i.e. an adrenal hormone as well as an ovarian hormone - and when taking HRT it can help with adrenal response - - more energy etc. but be careful as it can also impede the thyroid - so you might need to up-dose a little to take that into account.
I'm not taking HRT, presume this was meant for O/P Bearthebishon
Hi Bearthebishon. As has already been suggested by the very knowledgeable Slow Dragon, I would stabilize dose of Levo first to avoid confusing the picture. I was on 80mg ( a hefty dose) oral Progesterone capsules daily for about 2 years, as Progesterone bioidentical hormone compounded cream and Oestrogel that I had been on previously not really working anymore. Progesterone caps really helped with menstrual issues and shoulder pain. I am in perimenopause. BUT be careful as progesterone increases the activity of thyroid hormones. Oestrogen increases the production of TBG ( thyroid binding globulin) a protein which binds thyroid hormone and makes it inactive. I was on much too high a dose of Progesterone which caused hyper symptoms ( I have Hashis and take NDT) Usually I struggle with more hypo symptoms. So I had to keep dropping the Armour dose, eventually I was on half the usual dose. After 2 years I ended up with adrenal fatigue amongst other things and my health crashed in Oct 2020. My dose of Armour at the time was much too low, TSH over 4 when usually it’s suppressed and very low/ low fT4 and fT3 when usually I have high fT3 and mid/ high fT4. I couldn’t raise Armour though even though my body actually needed a higher dose, because the Progesterone was giving me major hyper symptoms! I stopped the Progesterone capsules in Oct/ Nov last year from one day to the next( major mistake as you should gradually faze them out, didn’t know better, doctors didn’t tell me either) and went into an extreme hypo phase. Took me 6 months to establish new ( old) Armour dose and I am still tweaking. Had to raise in autumn with colder weather. My cycle dropped from 20-21 days in Oct 2020 to 8-14 day ‘cycles’. Complete nightmare. Am on new compounded bioidentical hormone creams since Nov/ Dec 2020: Progesterone, Estradiol, Estriol ( both Östrogens), DHEA and hydrocortisone. Have been increasing dose of Progesterone and Oestrogen slowly cycle by cycle and am starting to have longer cycles again with fewer horrible symptoms.
Sorry, that was not supposed to turn into my life story!!🙃
Summary: stabilize and optimize thyroid with Levo and then start low and slow with hormones creams/ capsules. Creams usually not as potent as don’t have to be processed by liver ( think that’s right anyway) and tend to be lower dosage anyway. Hope that helps and good luck🍀
Here is where I found some of the science- based info I mentioned above.
thyroidadvisor.com/progeste...
Thanks so much....its all so blooming confusing. I've put my HRT away in a drawer and will wait until my levels are right first. 😊
You are very welcome. My long road to recovery is a combination of Armour NDT, bioidentical hormones, correct and optimal vitamins, minerals and other supplements, as well as LDN ( low dose Naltrexone) for inflammation and pain control. Wishing you all the best and wrote again if you have any questions.
I fully agree to avoid multi vit for now with the iodine as your thyroid is failing, and I’d get tests as recommended.
Based on your results I agree that you’re going to end up needing quite a bit more thyroxine and that does take time to raise slowly unfortunately. And aim for below 2, ideally 1.
This is as the half life of t4 is long, around a week.
Thyroid levels affect menstrual cycles and fertility etc so if you’re peri menopausal you could see an improvement - however it takes a good 3+ months *after* your thyroid is stable.
Whilst I agree it’s better to treat the thyroid first so that you have a baseline, and you know which symptoms you’re treating, there is an argument to treat with both barrels if symptoms are bad enough. If you were to do this you’d have to not alter your hrt at all, stay consistent so that that is a separate base line, incase of interactions, and continue testing thyroid and adjusting.
I’ve just started patches and am using progesterone vaginally sequentially, so 12-14 days a month and then a bleed. I’ve been *told* that transdermal oestrogen patches (like the gel) don’t affect thyroxine levels as it’s not going through the liver. Oral does definitely, but the answer is to increase thyroxine. If you take progesterone vaginally it’s also not going through the liver. However a couple of women in a meno fb group said they did have to raise thyroxine on transdermal and there’s so many different antibodies we are all different. Other women didn’t. Davina Macall is on 100 thyroxine (has been hypo 20 years) and transdermal hrt doesn’t seem to affect her either.
I’m currently doing an “in-house experiment” (😆) as I know what my levels were pre hrt and will be asking for a test at my 3 month review *before* I consider an hrt dose change. I’ve always had to go right up during pregnancy.
I’m only adding this as an alternative option simply as my own peri symptoms have been so awful - like cfs, intense joint and bone pain, nerve tingling, over heating at night, burning hands and feet, brain fog, lack of concentration, insomnia - despite perfect thyroid and everything else results, that I was going to have to take a long period of time off from work if I’d not been given hrt. The difference only a 37.5 oestrogen patch has made in a month has been unbelievable. I improved ferritin and b12 prior to this and noticed a little difference but not as much as patches.
Either way, be consistent and get the repeat tests (I’d do 6 weeks) and adjust. If you do decide on hrt, stick on the same dose till thyroxine is fully stable. Consistency and tests and noting symptoms or hopefully lack of, are key.
“Technically” transdermal oestrogen not an issue…
Recent guidance on taking progesterone vaginally off license; take same dose as prescribed orally. By passes liver and targets the uterus through vaginal absorption:
My Gp said I could choose. I couldn’t risk being more of a zombie or over anxious which is what some women experience but some women find it fantastic for sleep and more relaxed. Everyone is different.
thebms.org.uk/wp-content/up...
Ps it’s all body identical and made from yams.
Thanks haggisplant. I haven't had periods for 7 years after having an endometrial ablation.....its just the pain I'm struggling with so much. Especially in my hips. Of course this could improve as my thyroid improves.
Thank you for your advice. I will hold off until my levels are good 😊
I’m v conflicted.
I’ve been hypo since I was 20 and very hypo at times. I’ve never had joint pain of any sort till I became peri menopausal. Never had weight issues at all, infect would loose weight. Better thyroid levels made no difference recently to my symptoms. Only hrt.
A month ago I’d have said start Levo first and wait; now I’d say just start both and get regular blood tests for thyroxine. The trans dermal gel isn’t *supposed* to affect thyroxine levels. Oral does as it goes through the liver. Progesterone will be daily 100? Take at night either vaginally or orally.
It’s so important for bone density. You could be waiting in pain for another 3-4 months. I was 50% pain reduction after a day on patches. And more energy. It had that much impact. Hrt takes a few months to fully impact too so I’d just start all now tbh. Thyroid test in 6 weeks, adjust, test again a couple of months later and so on.
Dr has given me progesterone tablets and oestrogel 🤦♀️Are the patches progesterone?
No patches are oestrogen, same as gel. It’s ok to use either gel or patches. Both are transdermal.
Some women find one or the other “better” but I’d start now and tweak later all thyroxine levels are sorted. After tweaking hrt I’d check thyroid levels again after 3 months.
I just found this by one of the top meno specialists, Dr Louise Newson, who is currently advising the nhs and gives free Gp training to them:
Interestingly she says sometimes thyroid levels get *better* with hrt.
Disagree about waiting. I’d start the hrt now. The gel is not meant to affect thyroid meds absorption but if it does better to get on it now so the next test in six weeks time will give you a true picture and ensure you get the increase you need. Also the hrt itself might fix some symptoms so defo start it. Once on it no one I know ever wanted to stop it, it’s good stuff. I found it hard to say if it affected my thyroid meds but really it’s irrelevant as most will be on both hrt and thyroid meds for many years or for life so start right away.
I have been on hrt for over 20 years now, tablet form, estrogen only as had full hysterectomy. I only take one every other day as years ago my gp said I should really stop now but since then there have been new studies which say that estrogen only is no threat. However I have been on Levothyroxine for almost 3 years now, I am wondering if it could be affecting my levels? Although my endocrinologist won’t up my dosage anyway, so I’ll probably be going private in the new year.
I use gel 3 hrs after taking Levo. I was not prepared to stop when I started Levo as my menopause symptoms are debilitating. You made need more Levo because of HRT but there are no reported interactions.
Wow is this a private GP or NHS - definitely wait until you have got some thyroid hormone into your system as oestrogen can cause issues. Start very slowly with both until you know whether it suits you - as progesterone can be a bit of a problem.
Not necessarily with transdermal. Dr Louise Newson would say do both. It’s a deficiency of both thyroxine and oestrogen.
I went on HRT over 20 years ago . Felt terrific on it. A mobile X-ray van came to our Town and I decided to go. Was horrified when I got a call back, had breast cancer 5 cm insitu. Had it removed ,didn’t have radium or chemo,been good since,am now nearly 86.
Hi, I just wondered what you have done about the oestrogel shortages? I’ve been suggested to swap to a spray however I didn’t know if there was another gel. Any help would be useful.
Thank you xx
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