I’ve always avoided the contraceptive pill with my thyroid issue, I didn’t feel it was the right thing to do.
I recently had an appointment with an endocrinologist, due to chronic insomnia, which I suspect is due to my low cortisol and low DHEA.
She hasn’t confirmed as yet her proposed treatment plan, as still awaiting some bloods, but has implied in a letter that she’ll likely treat with COC like Tibolone, from which I presume she means HRT (Im 48 and until the last 3 months have been regular as clockwork on my cycle with no signs of menopause).
My question is, what do the experts here think to taking HRT with Hashimotos please?
Thanks in advance for any advice.
Written by
CornishChick
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I’m no ‘expert’ on the subject, but I’ve had no adverse reaction to taking thyroid & HRT medication. I found Dr Louise Newson’s book and ‘Balance’ App very useful for information & links. It’s all about personal choice and (for me) the benefits of taking HRT outweigh any risks.
Oestrogen increases the amount of thyroid binding globulin in your blood. (Which is one reason Total T4 is not a good test - because, as oestrogen increases, so does Total T4 - but Free T4 could be reducing.)
Estrogen has a well-known indirect effect on thyroid economy, increasing the thyroxine binding globulin [4], and the need for thyroid hormone in hypothyroid women [5]. Direct effects of estrogen on thyroid cells have been described more recently [6], so the aim of the present paper was to review the evidences of these effects on thyroid function and growth regulation, and its mechanisms.
Thank you Helvella. I’ve read this a few times and it’s a bit technical for me! Am I right in thinking it might be better not to take HRT due to the effect on the thyroid?
TBG is processed in the liver and taking HRT by patches or transdermally will bypass the liver.
However, I have noticed some members still need to increase their Levo dose with these HRT's and attribute this to the small amount that is recycled through the liver.
It is also reported that TBG is higher in women between menarche and menopause .... And pregnancy.
I discussed Tibolone with my doctor last year. I was told it should not be taken until you`ve been period-free for a year, just like you should use cyclical HRT rather than continuous HRT until it`s been 12 period-free months. If you start on it earlier, you risk spotting and break-through bleeding. I have successfully used HRT with Hashimoto`s. I never felt optimal on transdermal estrogen so switched to oral which works much better for me. Although it is often said that transdermal E is safer, I have found one doctor who says oral estrogen offers better cardio-vascular protection and affects both HDL and LDL cholesterol levels whereas transdermal E doesn`t.
Thank you PurpleCat71. I think this endo is crazy then as I haven’t even missed one cycle. I knew she didn’t have a clue and I don’t have menopause symptoms. She might think my chronic insomnia counts, but I’ve had it for 18 years and been regular as clockwork, so it’s clearly not menopause related. I have had some bloods back, do you know which ones specifically relate to the menopause please?
Your doctor is attributing your symptoms to imbalances in sex hormones such as we get during (peri)menopause.
Because you haven't reached menopause she is choosing COC over HRT. Whereas HRT will replace hormones missing due to ovaries stopping production, COC will replace hormones whose production will be enforcibly stopped through use of COC. The thought behind COC is to stabilise hormones as opposed to experiencing the fluctuations of peri-menopause.
It took my endo a year to persuade me to supplement HRT and when I did it was the best thing ever, (almost as good as when I started T3 😁). No hormone works on isolation but altogether, and replacing my missing O & P helped my thyroid hormone meds work more effectively. I had also suffered terribly low cortisol & DHEA for years (under-range at times) but optimising other hormones (ie thyroid & sex) allowed these levels to vastly improve.
However, if you aren't missing these hormones yet, still have regular periods indicating hormones aren't widely fluctuating, and don't want to medicate a combined oral contraceptive then you must discuss with your endo. COC contains higher amounts of oestrogen than standard HRT, and this is only good if you need it, otherwise just increases the associated risks.
If I was you I would concentrate on optimising thyroid meds and raising cortisol perhaps through use of an adrenal glandular or adaptogen. Menopause bloods will include tests such as LH, FSH, etc, with FSH looking high and estradiol low for menopause confirmation. Post results for members to comment if you wish but with regular periods you clearly are not menopausal.
LH and FSH levels (luteinising hormone and follicle-stimulating hormone). They rise with age. Also, estradiol and progesterone (labs have different ranges for pre-ovulation, ovulation, post-ovulation and menopause). If still having (fairly) regular periods, you should go to the lab on day 19-21 of cycle, so after ovulation.
Thank you. The endo didn’t ask me what day of my cycle I was on. Is she able to interpret my results correctly not knowing this? Should I be asking for the bloods to be redone on day 19-21 please?
On the subject of HRT, my Endo told me: "Take them as long as they (OB/GYN) will give them to you. They help keep everything else in balance." I'm 82 and still take them. ................. Taking contraceptives might be a totally different matter. I don't know.
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