Need help with Oestradiol and thyroid blood results ASAP please!

[Serendipitious]

I've just received my Medichecks results from yesterday and to say I am alarmed about the Oestradiol result is an understatement. My oestradiol is LOWER than when I tested before starting HRT in September 2022!

20/09/2022 results

134 pmol/L Oestradiol

Yesterday's blood draw was at 9.15am and fasting. Last thyroid meds taken at about 24 hours before. Utrogestan taken 12 hours before. Last application of Oestrogel 24 hours before.

Current meds:

100/75mcg Levothyroxine - alternating doses, since GP moved me from 100mcg due to low TSH. TSH has improved slightly as it was something like 0.08 before. This is a big deal for me as it was like that for years and maybe the HRT has helped.

3 pumps of Oestrogel daily each morning. Started HRT 30/09/2022, initially started 2 pumps daily for about 4-5 month. Then transitioned to 3 pumps daily about 2-3 weeks ago due to increase in symptoms.

100mg Utrogestan nightly each day

1 vagirux used locally twice a week

For reference, I am aged 45. Periods stopped September 2020, came back for 2-3 months in July 2021 and then MIA again then onwards. HRT started in October 2022.

11/4/2023 Results:

Female Hormones

Oestradiol 91 pmol/L

Progesterone 5.8 nmol/L

Prolactin 230 mIU/L Range 102-496

Thyroid

TSH 0.28 miu/L Range 0.27 - 4.2

FT4 15.4 pmol/L Range 12-22

FT3 3.3 pmol/L Range 3.1 - 6.8

Recently I noticed that since the Oestrogel packaging changed I started to feel a return of many of my symptoms, more brain fog and more recently incredibly disturbed sleep. Joint and muscle pain. Increased hair loss and very dry skin.

I know I left 24 hours before my last application, not sure if this is the correct way to test. But still my Oestradiol levels are much lower than before starting HRT and this can't be right. Is this correct way to assess oestradiol levels? I suspected they might not be good but I didn't expect this.

I asked to switch to Lenzetto a few days ago. However, I have not yet received my prescription. Going to ring the GP right now!

PLEASE HELP!

[london81]

your free t3 is very low. I recall you said you can’t tolerate t3 but clearly you aren’t converting the levo to t3 so you will feel awful

Your oesterodil is also low as you say which indicates either an issue with the product or absorption issue

[Serendipitious in reply to london81]

london81,

Yes the FT3 is also an issue. Yes I am suspecting either I am not absorbing anymore or the product has changed.

GP's receptionist has confirmed that they have issued a prescription for Lenzetto spray and they've even given me an appointment for this afternoon.

[SarahJane1471]

my immediate thought is you should have used your HRT before the blood test. You are replacing estrogen do you needed to see your levels whilst using the HRT. 🤷‍♀️ of course it will be low if you haven’t taken your daily dose. Surely you want to see what your levels are WITH the addition? Also I’ve never had mine tested because as you are going through menopause ( which can be 10 years) your level will fluctuate daily. I go by symptoms. If my symptoms come back I just increase my dose for a couple of days. Sometimes 5/6 pumps. I think you may be overthinking the HRT issues a little 😬

[Serendipitious in reply to SarahJane1471]

SarahJane1471,

Thanks for the reply. I wasn't sure what to do and so I thought that was the best course of action. Having said that, going by symptoms I feel I am getting progressively worse each day. Remember I spoke to you about the Oestrogel change of packaging? I think something has definitely changed for the worse. Apart from not being able to sleep properly, now I am feeling very hot at night as well.

Surely, EVEN if I hadn't applied the gel for 24 hours my levels should still not be as low as that?

[SarahJane1471 in reply to Serendipitious]

I haven’t had a problem with the new gel. If it were me I’d just put the dose up to 4 pumps 🤷‍♀️. See how you feel after a couple of weeks. It won’t do you any harm it’s just a replacement hormone.

Only my opinion though😬

[london81]

also just to say I get regular periods and my oestrodil was 134 a couple of years ago so yours was likely to get lower over time so you might need more.

On that test with medichecks they also test antibodies and testosterone don’t they, what were those results like? It could be you had a hashis attack which knocked your body. I’m noticing as my hormones go wild my thyroid fluctuates and my free t3 goes up and down ( I have hashis too)

[Serendipitious in reply to london81]

london81,

It really depends on what day of your cycle you test oestradiol. I would be incredibly surprised if you were that low throughout your cycle else you wouldn’t be having periods.

I didn't test antibodies, I did the basic TSH, FT4 and FT3 test. My antibodies have generally been quite stable for some years now thats why I didnt retest.

[TiggerMe Ambassador]

I'd be much more concerned with your low T3/4 levels! (I was on my knees with those readings) classic crossover symptoms, these lows will be having a knock on effect with your oestrogen levels as your system slows down and prioritises more important functions

What was your FT3/4 when you were on 100 levo every day?

Certainly worth trying Lenzetto which I find very good and easy to adjust your dose, with this reading being your bottom end you may have just caught a down day as things still fluctuate, but you won't know what your absorption is like unless you take another test after slapping on some oestrogen. I find my levels drop quickly which is a good thing as you don't want to over do it else it can inhibit you conversion of T4

But your immediate issue is getting your thyroid levels up 🤗

[Serendipitious in reply to TiggerMe]

Eeyore100,

I do feel like I'm on my knees. I'd have to get back to you about my previous results but FT3 was around the same. I don't know what to say to my GP. She probably won't increase Levo back again. As far as they are concerned TSH is getting better and FT4 is "normal". It's so frustrating. I will definitely relay this to them today.

[TiggerMe Ambassador in reply to Serendipitious]

TSH 0.28 mIU/L (0.27 - 4.2) 0.3%

Free T4 (fT4) 15.4 pmol/L (12 - 22) 34.0%

Free T3 (fT3) 3.3 pmol/L (3.1 - 6.8) 5.4%

T4:T3 Ratio 4.667 

I think I would go with the argument that the TSH is testing your pituitary gland and if they would like to investigate this further you would be very happy but in the meantime your actual FT3/4 levels are woefully low and need raising! Please 😉

Looks like you could at least do with gradually going up to 100/125 alternate days

[FancyPants54]

Don't worry too much. A lot of us have problems absorbing the gel. I could not get on with Oestrogel at all. It gave me a hit when I put it on. I would pour with sweat from my head before I'd had chance to get dressed. And then in the evening I would feel like everything had just drained away and left me miserable. I found Sandrena gel better than Oestragel actually. But even so, the gels were not a good fit for me now I'm older and have been trying HRT for a long time.

You have Lenzetto now to try, I like Lenzetto. But it's weaker so you will need to start with 3 sprays a day probably, or work up to it fast, and then probably 4. Have you tried an oestrogen only patch? Basically, you have to keep trying HRT products until you find the one that feels right for you. Go by symptoms, not bloods. It's remarkably unreliable by bloods.

[Serendipitious in reply to FancyPants54]

FancyPants54,

Thanks. Sorry to hear about your experience. What extreme symptoms! Today the GP was toying with the idea of prescribing oral oestrogen when she saw my Medichecks results. Then said she'd need to get advice from the hospital clinic first. She confirmed that Lenzetto has been prescribed and said I should start with one spray. I asked her surely thats for people who havent taken any HRT at all? She then said yes start with 3. Aargh! Then Boots had amber stock warning which meant it might not arrive tomorrow. Thankfully another chemist had green stock levels so they may have it available tomorrow for me to collect. GPs also dont even realise they're only giving me barely a month's supply. So frustrating, I hope I have enough gel left to at least get tomorrow's dose. However, judging by how I feel right now it doesnt seem like Oestrogel is doing mch at all.

You're taking oral oestrogen too aren't you? Are you getting better results or does it affect thyroid etc?

[FancyPants54 in reply to Serendipitious]

One spray is classed as very low dose! You don't need that. You will need at least 3 sprays a day and probably more. There was a big shortage last year but it seems to have settled down now. Try independent pharmacies, not Boots.

The Bijuve capsule is the first ever combined body identical oestrogen and Utrogestan product on the market and it's great. I really like it. It keeps my levels more even. But my last reading was quite high, hence deciding to try a reduction in Lenzetto from 2 sprays to 1, which I have carried out this week. However as a product it's only 1mg and classed as a medium dose product I think, or it might even be a low dose. That's why I kept up with the Lenzetto too. But I know when I get too much oestrogen for my body I bloat up and have very painful legs and feet with the fluid. I had got to that stage and that's why I wanted to try a reduction. So far my mood is a bit lower but I'm peeing more.

I don't know what effect it has on my thyroid meds. Every little thing affects them! I'm now on NDT and just had to reduce dose as I got a high heart rate develop. The HR dropped with the dose reduction. But now I've lowered the oestrogen, the HR is rising a bit again so I think it might have to reduce thyroid even more at some stage. For now I'm letting everything settle.

[Serendipitious in reply to FancyPants54]

FancyPants54,

You were right, Boots weren't sure they could get it as their single supplier source had a yellow stock indicator. I went to another independent pharmacy who have several sources and one was green. So I managed to get a bottle. Thanks. You really don't get much in a bottle by the looks of it. So 54 sprays will barely last a few weeks if I use 3.

How did you manage to get Bijuve as well as a transdermal oestrogen? Private route? I'm assuming oral oestrogen isn't that high a dose?

I'm wondering whether the insomnia I'm experiencing of late is due to me going from 2 pumps to 3 pumps of oestrogel. Maybe that is too much for me as I've read insomnia can be due to too much oestrogen. It's all very confusing.

[FancyPants54 in reply to Serendipitious]

You are correct to assume I use a private clinic for the diagnosis and prescription but my GP is happy to carry the prescription on for me. The Bijuve capsule is 1mg. I am overweight and so have to be aware of the risk of a clot on the capsule. But nothing else was working very well for me and so as I am already taking an anti clotting medication for my heart arrhythmia, the clinic doctor thought it was worth a try.

It's apparently working well for me.

[TiggerMe Ambassador]

Looking back at your results when you started HRT and I think you were on 100 Levo daily you were low then and should have had an increase in Levo, adding HRT often needs an increase in thyroid meds too and yours has been reduced which is why you are getting all the Hypo symptoms returning.

You are being bullied to lower because of your low TSH, you need an increase and you might have to get cross with them! 😠

Older results

[Serendipitious in reply to TiggerMe]

Eeyore100,

I tried having more than 100mcg and it left me feeling jittery and anxious. So that wasn't for me either. Well my former GP was really bad, he dropped me down to 75mcg without even asking me. At least with this practice we negotiated it and I said I will try alternating between 100/75 and then we can see. Hands are often cold and sometimes numb too. So its not helping.

[TiggerMe Ambassador in reply to Serendipitious]

Shocking isn't it!! Do you split your dose?... it helps some people

Have you tried asking for a referral to an Endo? (not a quick fix but worth a shot long term)

Have you checked your cortisol levels?

Have you previously tried T3?

With your fT4 this low you don't stand much chance of getting your fT3 levels up to warm you up!

[Serendipitious in reply to TiggerMe]

I dont no. I tried that and I found that awkward. Also having less Levo in the morning didn't feel good.

I was meant to see an NHS endo on 18th April but they cancelled my appointment last week and rescheduled it for Sept 2023!

I've not recently checked cortisol levels.

Yes T3 gave me insomnia and nausea! Tried it twice. I split the smallest tablet. So annoying.

[TiggerMe Ambassador in reply to Serendipitious]

Hmm, I'd recommend a saliva cortisol test with DHEA which might give you a spotlight on why you struggle with T3/4 as being high or low creates an issue it seems

[TiggerMe Ambassador in reply to Serendipitious]

Perhaps keep your morning dose the same and add a little extra later?

[Poppycat999]

I cant really help but l can tell you that l came off of HRT 2 pumps gel and progesterone tablet as it raised my TSH levels and l felt terrible that was after 3 weeks of HRT. I'm feeling better off it. I took 100 levothyroxine after finishing the HRT l was in a terrible state on the bathroom floor totally weak no energy tired but unable to sleep at night. Its took a long time to feel better now I'm on 50/75 Almus levothyroxine alternate days. Feel ok unless l drink alcohol get a headache and wierd tingling rushing sensation. Got that before treatment! Was bad before now feeling alot better. I also have vagifem twice weekly. Late menopause 58. Hormones are complicated we all seem to need different meds but l judge it all now pretty much on how l feel as that's the important thing.Good luck to you

[FancyPants54 in reply to Poppycat999]

3 weeks was not long enough to know how HRT was going to work for you. You need to give it 6 months at least. Rather than stop it, you could have tried increasing your thyroid dose a little to compensate. It has taken me a long time to get my HRT right with my difficult thyroid, but I have persevered and tried different products and delivery methods for a long time to find what's best for me. I have seen my mother crumple and disintegrate with both kinds of arthritis and osteoporosis. I am not willing to go the same way without a fight and my HRT is the leading weapon in the fight.

[Poppycat999 in reply to FancyPants54]

Hi we are all different l feel better without it. My mum lived to be 92 nearly 93. She did have dementia really bad but otherwise ok no arthritis or osteoporosis. My menopause was at 58 so very late. I feel so much better now. Good luck in your journey

[GlowCoach Administrator]

I can't comment on HRT but yor thyroid levels are too low as you may be aware.

However I haven't seen you post your vitamin levels which are just as important. When hypo we get low stomach acid which means we cannot absorb vitamins well from our food, regardless of a great diet. For thyroid hormone to work well we need OPTIMAL levels of vitamins. Have you recently or could you ask your GP to test levels of ferritin, folate, B12 & D3? Private tests are available, see link for companies offering private blood tests & discount codes, some offer a blood draw service at an extra cost. thyroiduk.org/help-and-supp...

[Serendipitious in reply to GlowCoach]

Jaydee1507,

I happened to do some at the GP last week, I just didn't have the FT3:

04/04/2023

Levo 100/75 Blood draw about 12.30

TSH 0.16 miu/L [0.35 - 4.94]

FT4 14.7 pmol/L [9.0 - 19.1]

Ferritin 70 ug/L [30.0 - 250.0]

Vitamin D 77 nmol/L [50.0 - 200.0]

Folate 9.3 ug/L [3.0 - 20.5];

B12 1174 ng/L [200.0 - 900.0];

Thanks

[GlowCoach Administrator in reply to Serendipitious]

Are you taking any supplements at the moment?

I see that you have tried T3 before. Were you supplementing at that time? Did you try a lactose free version of T3?

Vitamin D should be around 100 - 150. Buy one that includes vit K2 to help it go to your bones. Some are available in oil or you can take it with an oily meal for better absorption. Use this calculator to work out how much to take to get your level to 100-150. wildatlantichealth.com/vita...

Folate - aim for a level of 20. Recommend taking an active/methyl (should say on label) B complex which contains 400mcgs folate (also B12). Occasionally some people require a higher dose of folate, often due to having MTHFR genes in which case buy a separate 400mcgs methylfolate and slowly add to your dose over several weeks. This B complex has all the right vitamins at a not unreasonable cost for 90 days supply. amazon.co.uk/Liposomal-Soft...

Ferritin isn't bad but a level of 90-100 would be better. Suggest increasing iron rich foods in diet and eating them often. Chicken livers, pate, red meat etc

B12 over range could mean that you are already supplementing or could be a paradoxical deficiency.

[Serendipitious in reply to GlowCoach]

Jaydee1507,

I didn't try any other form of T3 apart from Thybon Henning and that was hard enough to tolerate. I suspect overactivation of the HPA Axis.

Yes I take 5000iu every other day with Jarrows Vit K2 MK7. Thanks for the link.

I bought some chicken liver yesterday and had some dinner. Thanks I'll do it more regularly.

I definitely don't supplement B12 and even supplementing doesn't help me much. Probably related to the way I metabolise it.

[GlowCoach Administrator in reply to Serendipitious]

Your folate could do with coming up a bit.

Free T4 (fT4) 14.7 pmol/L (9 - 19.1) 56.4%

Have you tried raising your levo dose? Thats a pretty low % for someone on Levo alone.

[Serendipitious in reply to GlowCoach]

Jaydee1507,

GP has just reduced my dose from 100mcg to 100/75 about 3 months ago. Previously tried 125mcg which made me feel anxious and overstimulated. I suppose one benefit is that my TSH is now not almost 0 but coming back into the normal range after being extremely low for years. No idea if HRT has helped there.

Is there a Folate supplement you can recommend?

[GlowCoach Administrator in reply to Serendipitious]

We usually recommend a B Complex that contains folate & also B12. This helps keep the B vitamins in balance. It doesn't matter if you have too much B12 as any excess will be excreted via your urine.

This B complex has all the right vitamins at a not unreasonable cost for 90 days supply. amazon.co.uk/Liposomal-Soft...

[Gerri030306]

I would say that you are not absorbing the Oestrogen that you are using at the moment or maybe need more. My Oestrogen level dropped and that was due to my own ovaries stopping producing oestrogen, so I had my dosage increased. I am using the patches. There is a maximum amount of Oestrogen that you can take if you still have your womb.

[Serendipitious in reply to Gerri030306]

Gerri030306,

I was able to get an emergency appointment with the GP that day due to a cancellation. She will ask the hospital clinic about what to do.

Did you ever use gel or the spray? Or did you start off with patches and only ever use a patch? If so how did you find they compared?

[Gerri030306 in reply to Serendipitious]

I started on tablets, but was recommended patches etc because they don’t get processed in your liver. I didn’t fancy the gels etc because I’m not a patient person lol. Patches are quick and easy for me. I have my Oestrogen tested every 6 months and that has been useful. I felt puzzled when my symptoms came back but when I got my bloods back I could see the Oestrogen level had plummeted.

[Serendipitious in reply to Gerri030306]

Gerri030306,

Thanks. Which patch do you use? I’ve heard Estrodot is a good one.

How low were your levels when they were very low?

Also, are you testing through a private consultant? I suppose my other question was whether you take your oestrogen before or after your test but as you’re using a patch it won’t matter.

[Gerri030306 in reply to Serendipitious]

I use Evorel Conti 50. It went down to 138, so they increased my dosage. I got it up to 346 before I went post menopausal. It’s now at 236 and I don’t know if I can have anymore Oestrogen but I’m going to ask.

I’m a lot older than you but I think it’s all very individual so it’s difficult to know at what stage you are in the menopause.

My Endocrinologist tests it for me when she checks my Thyroid.

Yes it’s on all the time, I can’t ever be without it now! Lol.

[Serendipitious in reply to Gerri030306]

Gerri030306,

You might be older than me but my periods have actually stopped although prematurely. Initially abruptly in September 2020, they only returned for 2-3 months in 2021 and now I haven’t had a period since September 2021. I was under 45 then.

I’m wondering if it’s worth me seeing an Endo who can help rather than waiting for my GP to come back with something. This really can’t be good for my sleep, bones, heart, brain etc! Plus my hair is falling out at an alarming rate and not growing back much at all. I didn’t expect this to happen to me. Really I should still be cycling at my age.

Good to hear things are working out well for you.

[Gerri030306 in reply to Serendipitious]

My periods never stopped but I was menopausal it’s very difficult being a woman.

Seeing an Endo is an option for you, but, find a good one using the help from this page. They need to test T3, T4 and your Thyroid antibodies. Most GP’s only use the TSH which is not an indicator of how your Thyroid is working.

Hair loss can be related to low iron so please get all your bloods tested: Vit D, Ferritin, iron panel, B12, folate. The team on this site have helped me enormously. Read on here as much as you can.

It has taken me 2 years to reach this stage. I take zinc, selenium and magnesium. They all help your thyroid.

Don’t give up, keep reading, you can get there.