Thyroid or menopause - which to sort first?

[Heappestre]

I've just checked the app, and the last of my blood tests are back. I definitely have started perimenopause and as per my last post I have high TPOab, high TSH (7.5 with high ref being 4.26), and lowish T4 (14.2 of a 12—22 range). I have symptoms that overlap the two conditions, but also symptoms that are uniquely one or the other.

So my GP will want to start me on some treatment when I speak with her on Friday, either HRT or thyroid. At least, that was last weeks GP plan. This week I have a different GP and the conversation my husband had with her today was a disaster, so I really could do with some honest advice before the call.

My question is on what has people's experience been in these situations. Has anyone started both at the same time? I think I want to start treating the underactive thyroid first, but is that a good or bad idea? If the GP doesn't want to start thyroid treatment now and insists on the results of a second test in 3 months before treatment, how will taking HRT impact this second thyroid teat?

Sorry for the amount of questions, but I'm really new to this (only my second post), and really insecure and anxious right now.

[TiggerMe]

If you have only had one raised TSH result the chances are they will want another before starting T4 so I'd say get started on HRT, ask for body identical either gel or spray for Oestrogen, Utrogestan progesterone is the standard and body identical..... balance-menopause.com/subje...

Over time you are going to need to balance both your thyroid and sex hormones so you'll have a good few months tweaking things 🤗

[Heappestre in reply to TiggerMe]

Funny you should link that website. I had a call with the menopause clinic behind that website, and they were useless. It felt like she was just rattling through a script and was trying to get me to agree to a treatment option rather than discuss stuff properly!

I'm expecting the two interact, but I'm trying to work out how, so I can make an informed decision rather than relying on a GP who doesn't listen to her patients

[TiggerMe in reply to Heappestre]

Oh, that's a shame perhaps their success has over stretched them clinically 😕 I've no experience of them but did one review with a Meno Clinic to get me up to speed on the best options and then instructed my GP as they were clueless.... I work on symptoms and an annual blood test to tweak my doses (but I'm post Meno now so things are more settled😅)... it's such a useful site for information and monitoring symptoms on the app

To be fair it is a bit of trial and error so clinics are only of limited use... I'd suggest you trust your own instincts when starting these things as like you say the cross over in symptoms are confusing, do your research and get them to prescribe your preferred options and then take it at your own pace is my advice, any hormone change has a knock on effect 😵

I see you've got Hashimoto's so this mixed with peri makes for a constantly moving target I'm afraid 😕

[TiggerMe in reply to TiggerMe]

I like transdermal oestrogen as it's easy to tweak but there is a body identical pill called Bijuva which might be worth investigating too 🤗

[TiggerMe in reply to TiggerMe]

... though that might only be available to post meno?

[Obsdian]

I started hrt before I had any thyroid issues so a different situation. I have been perimenopausal for years (started just before 40), started hrt at 45.

Perimenopause is not straight forward, your hormones are like a roller coaster and you may find your dose needs adjusting regularly. Some find that journey easier and doses more stable but a lot don't. My hormone ups and doens are getting longer which makes it easier to stay stable.

Perimenopause can feel awful, mine definitely did before hrt, found it hard to function and was at the point of considering to quit my job.

But, now having experienced and learned about thyroid too, I feel like thyroid is more serious to your body as it affects every cell. To me personally, that's more urgent if I had to choose.

Also, estrogen affects your thyroid levels, maybe dealing with both is better done by sn endocrinologist?

I'm not an expert and am stuck feeling like a newbie.

[N5girl]

I can’t advise on which to treat first. However, what I would say is that in my experience HRT worked really quickly - I felt tangibly different within a couple of weeks. From what I remember progesterone made a difference to my sleep within a few days.

So maybe reducing / removing peri symptoms, might help your case with the GP?

There are loads of menopause resources out there now but I found ‘Stacy Sims : Next Level’ really, really helpful at explaining the myriad of different symptoms. Ignore that it is aimed at athletes - it is a US book so she just means anyone who gets off the sofa occasionally- 90% of the book applies to any woman.

[Buddy195 Administrator]

That’s a tricky question! For me, the thyroid symptoms came first, so it was a straightforward choice. I think I would tackle both at the same time if I were you, but go low and slow when increasing dosages, so you don’t miss your sweet spot where you feel most well. Many members report needing slightly more thyroid meds with HRT, but I’ve actually found I needed less.

[CoeliacMum1]

Quite tricky… one making the other worse but one hand start hrt and thyroid might get dismissed and on hrt some symptoms may improve… I think hold out for getting both treated even if in 3 months your GP say retest thyroid.

No need to go to a specialist your GP surgery should have a menopause/hrt clinician that can give you what you need it’s all based on your symptoms.

If you get free prescriptions (re if diagnosed hypothyroidism) your hrt prescription will be free also.

There’s a special one off charge on NHS for hrt prescription if you pay for medication the pharmacy should tell you this also.

[Heappestre in reply to CoeliacMum1]

Unfortunately the GP specialising in woman's health passed away in January, so the surgery is currently without a clinician specifically for menopause.

I'm not after being referred anywhere else. That'd take months and I want to get this sorted now. I'm not normally impatient, but this is impacting work and I can't have that

[CoeliacMum1 in reply to Heappestre]

Any GP can prescribe it they don’t have to be specialist but usually helps to have one with more knowledge, it doesn’t have to be a GP either some nurses and practice pharmacist can give you these if had relevant training if you have these.… see if your regular GP can help that might be quicker … if you have been on balance website/app there’s help to get you through the appointment and not to be fobbed off.

Specialist Clinics are very busy as there more demand as this area and in the last 4yrs has picked up speed.

Do places like Nuffield & Spire private hospital types run any menopause clinics?

I know there was talk sone time ago (I don’t know if been overturned) of new patients having to get cognitive behavioural therapy (CBT) before going on hrt in new guidelines being published - not sure if that’s implemented .. it may have its place alongside hrt for certain criteria but not as a need beforehand just another obstacle again in women’s health!

[gabkad in reply to CoeliacMum1]

Yup. The Baby Boomer generation is enormous and we have expectations in regards to quality of life. Whereas I think the older generation just quietly accepted their fate.

I have no idea how CBT can help when the 'problem' is easily tested for and it's all about hormones which are tangible molecules.

In my experience the best anti-depressant is HRT. Hot flashes would wake me up multiple times every night severely disturbing my sleep. Once on HRT I could sleep the night through. I read that not getting restorative sleep is as bad for driving a car as is being drunk. Brain fog and exhaustion: a terrible combo.

[SecondAngel]

I'd get HRT sorted first if that's what the GP suggests, sometimes it is best to play the long game.

As a general tip: I find looking at the NICE guidelines helps when dealing with GPs as that is what they use - what key symptoms are they looking for, what are they looking for to give a specific treatment? Use the key words, talk about the symptoms you have that NICE reference etc.

[Heappestre in reply to SecondAngel]

NICE guidance is unclear on auto immune thyroid issues, it seems to ignore the autoimmune part! And NICE guidance states that thyroid issues in women is often mistaken for menopause. But offers no suggestions on what to do if it's both. So no help there!

[tattybogle in reply to Heappestre]

NICE guidelines advise GP's that an over range TSH result needs to be confirmed 3 mths later before they can consider starting any treatment for subclinical hypothyroidism .

So (assuming this is your first raised TSH) , the GP can't start Levo yet in any case.. so perhaps you might as well get started on the HRT while you are waiting .

as for what effect starting HRT would have on TSH / thyroid hormone levels ... it's impossible to say as we are all individual and the body's balancing mechanisms are complex .

eg. some of us that have been on a stable dose of levo for decades find we need less levo following menopause... but not everyone . And estrogen has it's own relationship with thyroid hormones , levels of estrogen influence the amount of TBG produced by the liver . (Thyroid Binding Globulin -TBG is what binds thyroid hormones T4 / T3 to carry them round the body ). and because of this, some people already on levo who start HRT will need to increase their dose of levo .. but not everyone .

So yes starting HRT and /or going through menopause may well have an effect on your thyroid levels , but the only way you'll know what effect that will be is to try it and see what happens next.

[sparkly]

That's a tricky one but hrt should be quicker to get prescribed than likely diagnosed and prescribed thyroxine.I'd say personally it will be a better foundation to get sex hormones balanced or in process as symptoms can overlap lap and you don't know what is causing what. Once peri symptoms like anxiety, rage, fatigue, ache and pains, brain fog, night sweats and hot flushes just to name a few are settling. Then tackle thyroid journey otherwise you'll not know what is helping what.

I had thyroid issues first then peri kicked in but i could have been peri from same time.

I had major issues with my thyroid medication not working when I was finally told I was perimenopause. Once on hrt my life and thyroid med issues settled. Wasn't an easy ride I can tell you. Also ask about testosterone once on hrt..it was the missing piece for me and made all the difference.

For me I have to have sex hormones balanced for thyroid meds to work reasonably.