Im 50 and started on combined HRT in the last 3 week to help with bad sleep and night sweats and i was fine with the oestrogen gel but when starting the utrogestan tablets i feel sick and dizzy and cant think straight, sore boobs.
I take thyroid meds for Underactive thyroid and wonder if the hrt is causing an issue related to the thyroid. I twice asked my gp for a face to face apointment before starting hrt which they declined and said not necessary and at no point mentioned and potential conflict with my existing thyroid treatment.
Anyone with similar experiences to share?
Thanks
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Rudders
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Regarding HRT, it may be useful to have a look at Dr Louise Newson’s free Balance App, as I find it really useful for comparing HRT medications & having up to date research articles. There is also an ability to post questions.
Many members report needing slightly more Levothyroxine when starting HRT, but I actually needed less. Do retest levels 6-8 weeks after being on a consistent HRT dose.
I swapped HRT doses/ brands several times to find a combination that worked well for me. I personally found it best to take utrogestan 1xnightly continuously than 2x nightly for a fortnight that I was initially prescribed. Do chat to your GP/ nurse practitioner/ pharmacist for other options.
Yes I was advised to do this by Newson health to reduce side effects of utrogestan. If you're on a daily dose of it then you only need to take it on alternate days vaginally. I've gone back to taking it orally so that I get the sleep benefits and the side effects have diminished over time for me.
Hi Rudders - I can’t tolerate utro or any form of usp progesterone at HRT doses, I can tolerate small amounts of progesterone cream, but I had to switch to norethisterone as the progestin component of my HRT. I’m not sure if the thyroid plays any part other than when I switched from combi tablet HRT to transdermal was when I started to go downhill. It’s possible the combi pill was masking a low cortisol/low thyroid as I know it works differently, but that’s when my ‘thyroid’ problems started. Utro is like poison to me, but synthetic I can tolerate. I think there’s definitely a link. Maybe ask your gp if you can trial a synthetic progestin?
My private endocrinologist told me off for stopping the HRT and said thyroid is much happier on it. Take the progesterone tablets at bed time as you get into bed.
I’m only on gel to rub into skin for HRT, but was told by both gynaecologist and endocrinologist that the HRT can require an increase in thyroid meds. I certainly found this to be the case. I needed two increases, on starting and when I increased my dose of HRT. Interestingly when I read around it a bit some women can need a decrease in thyroid meds after menopause which might explain why GPs get so over attentive when you hit that age. I think the perceived wisdom in the medical world is your osteoporosis risk goes up with suppressed TSH after menopause. However HRT can be a protective factor for osteoporosis, an argument I have used when ‘discussing’ TSH levels with my GP/endo……
The main thing is to find a dosing combination of both that works for you, good luck!
Yes Utrogestan is horrible but I wanted a bioidentical replacement progesterone so went for Crinone ( only available privately as license is for fertility treatment not HRT).
Yes you will probably need to adjust thyroid treatment to keep your energy levels off the floor.
Hi, Three years ago, an endo told me, I was not absorbing levo due to low estrogen levels. I was many years post menopause with absolutely no menopause symptoms. I took tablets prescribed and it completely blocked my meds. I became like a zombie - really spaced out! It led to disastrous consequences. So, yes it definitely can greatly affect thyroid meds. I do not understand why estrogen had a huge impact on me when others will say it has little or no affect. The only thing I came up with was that my thyroid function was already very low as I had an absorption issue, and the estrogen made it sufficiently worse for it to have a huge impact. I was put on liquid levo which has been a great help.
All your hormones interact but nobody seems to allow for this. Oestrogen definitely affects thyroid levels. Some say only oral preparations affect each other, but I have found that is rubbish too.
No sorry, I went straight to Crinone and it worked for me so I stayed with it. Unfortunately I have been unable to persuade NHS to offer and so it costs for prescriptions and private consultations.
I suspect the problem is that some people need a different/ lower dose than others but nobody knows how much, so doctors just go with the sizeable Utrogestan dose to be on the safe side and it does not suit everyone. If only there was knowledge about how to work out how much we need it would be much better, like thyroid testing where the dose is less important than what it does to levels in your body.
Although not taking it orally should help a lot of us - using vaginally increases levels in uterus (where it is needed after all) more than oral so should need a lower dose - unfortunately we still don't know how much. 100mg vaginally (e.g. cyclogest or crinone or utrogestan) should be more effective than 100mg orally (utrogestan) but guidance is to use same amount whichever route! If you are sensitive, using more to be on the safe side is likely to be a problem.
Crinone has 90mg in sustained release form and I use it alternate days, no zombieness or break through bleeding but sends g.p./ NHS into panic mode. It is tested and approved for fertility treatment but has not been licensed for HRT.
I have had one scan so far and no problems. As I need the Oestrogen to keep arthritis at bay and so have to have progrsterone, it seems worth the (small in my view) risk as the standard NHS one size fits all approach does not seem sensible. Perhaps it is mainly us thyroid suffers who get the problems?
Thanks AKatieD - so that’s approximately alt day vaginal utro which I tried and couldn’t tolerate. Did you find a marked difference between the 2? What dose of oestrogen do you use? Mine is low and I’ve tried 50 Cyclogest vaginally daily but always end up the same zombie after 3 days.
Definitely, completely different from the outset. I tried every 3 days initially but was getting a breakthrough bleed so switched to every other day. I have 4 pumps Oestrogel.
I wonder if it’s the slow release nature of it that ameliorates that ‘hit over the head with a spade’ inevitability. How about other side effects, swollen breasts, bloating, black dog depression, back ache, I could go on…
Yes! The sore breasts are a sign of too much progesterone out of balance. I had this when starting HRT. They reduced the ratio in the bioidentical dissolving sublingual tablet (compounded) and soon all was well. I needed less thyroid medicine and was able to reduce that as well. These things are so individual. To make it even trickier, it changes over time. You may need more or less as you go on, keeping in balance with thyroid meds. Now I’m tested every 6 months with full panels for both at once but in the beginning it was every month, making slight adjustments based on symptoms. The commercial HRT products I was hoping to use (simpler, less expensive) did not work right (or, they worked fine but I reacted badly to them) . But once the bioidentical compounds were started, (sublingual dissolving tablet of some progesterone and more estrogen, I think it was then 20/80 ratio, now 10/90), plus a very low dose of testosterone gel (for muscle and bone strength and libido), i was able to reduce my thyroid meds from levo 100 + liothyronine 50 down to levo 50 + liothyronine 50, and finally off levo and only lio, first 75 then 50 then 37.5. At 65 I feel better than I did at 40 and am stronger, with better overall health and energy.
Ask to reduce the progesterone side—-classic symptoms of the ratio being off. If they won’t, you could try a slight reduction for a couple of weeks and see how you feel; every person is different.
This is in the US, but when I lived in the UK the GP was willing to try and curious and interested in seeing what happened, but I had to wait too long for an endocrinologist consultation; then they were able to approximate what I had been taking, in a private clinic. It was not easy to persuade but eventually it did work out.
Wishing you best of luck in finding just the right combination.
Britomartis29 please tell us a little more about how to set the ratio 20:80 or 10:90, how it changed etc and let us know if there is somewhere to read about this approach. Thanks
If you can persevere a bit longer it will likely pass. I had same when started estrogel, dizzy as hell, couldn't drive, couldn't walk down stairs. Was told to persevere and it would pass, which it did.Utrogestan can have a welcomed sedative effect for a lot of us, I couldn't sleep to 2/3am before taking. Also can have a calming effect.
Your body needs time to adjust to having the hormones again. Give it 2 months and if still same either try vaginally but you won't get sedative effect or if really bad and new symptoms than perhaps move to patch
Yes, not everyone can tolerate it sadly and can have horrible side effects. I'm 99% sure I'm post menopause now and feel balanced. Perimenopause was hell for me, totally played havoc with my thyroid medication.Having been through it you realise that what ladies think is down to thyroid issues is actually due to Perimenopause, that was me some 7/8 years ago.
Progeterone intolerance is real (PMDD) and it's unlikely you will ever really 'tolerate' it, it's just a matter of finding a way to get through it. I didn't know this until I consulted with Professor John Studd, sadly now departed, but he asked all sorts of questions like types and pre periods/pregnancy/post pregnancy and said I was unlucky, intolerance is a real problem, particularly when it comes to hrt. He said I could consider a hysterectomy if I wanted to continue with HRT as there's no way of getting round the progesterone/progestin component. And I've tried all of them.
One thing you didn't say is whether you are still cycling or fully menopausal or what you dose actually is for both the gel and Utrogestan.
Yes, a lot of women find that vaginal application of Utrogestan is better than oral and there is definitely a link between sex hormones and thyroid. Typically it's the estrogen which makes the absoption of thyroid hormones less effective and often necessitates the raise in thyroid hormones we take (can be true for both levo and T3).
Sore boobs is actually also a typical sign of too much estrogen and problems with progesterone are very often the result of too little progesterone in relation to estrogen, effectively it's progesterone deficiency which is more of a problem than the low oestrogen, especially if you are still in perimenipause. You can have low oestrogen but if your progesterone is non existent it really needs addressing first, especially than progesterone has many more functions in the body than just womb protection, nerves myelination being one of them, and prog receptors are found in many tissues and cells in the body including the brain.
You also need to have enough carbs with progesterone for it to work efficiently so having it with a snack or a meal often works better than on the empty stomach despite what the official recommendations are. It really is worth reseraching progesterone a lot more and looking beyond the official 'only oestrogen is important' paradigm especially if you also even had hormonal problems like PMS or PMDD during your younger years.
I took HRT and thyroxine for years no problem but there are different HRTs so tell your doctor about the side effects. You may just need to change type.
Hi there - I'm amazed no one has mentioned a Mirena coil for delivery of Progesterone, but it's worked very well for me. It is a synthetic progestogen, but in such small concentration as it's right at the root of where required.
I was originally on a combined estrogen/pregesterone oral pill and had after a year or so started to have some bleeding. I was then prescibed estogen patches and Utrogestan but just couldn't tolerate it (like PMS on steroids) with very much the same symptoms you describe. I always had really bad PMS so I clearly have a problem with Progesterone.
I didn't try Utrogestan vaginally though, and can't really remember why not, but instead opted for a Hormonal Mirena coil, which has been fab and I honestly haven't looked back.
I'm also Hypo and read on the Balance app that Estrogen in particular might bind to some of the same sites as Levo, so was prepared for a fight for an increase, but haven't really noticed any need for this.
My problem, which is mirrored by the community here, is that my TSH is always suppressed when I'm feeling my most well i.e. Levo at 125mcg/d with some self sourced Lio 6.25mcg/d and my GP is always trying to lower my NHS Levo dose.
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