I am 61 years old female and definitely post menopausal. I have just received a letter following my recent endo appointment and it states that oestrogen levels were negligible and fsh was 19. I just want to check if this is normal. I thought the fsh should have been much higher.
My tsh has never risen despite extremely low levels prior to treatment so I am wondering if there is a problem with my pituitary. I would have thought the endo would have picked this up but perhaps not.
Thank you so much for any insight.
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Eton
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Thank you....of course! Weary grey cells at age 79!!
I think your next move should be a Full Thyroid Test ...pituitary probs usually show as low TSH and low Frees. Your suspicions could be correct, thyroid labs will help verify
Treatment is replacement thyroid hormone(s).... raise thyroid hormone (TH) dose to therapeutic level
If (cellular) T3 is low all, or any part, of the body will be affected
I suspect low THs are contributing to your problem....do you have recent labs ( with reference ranges) that you can post
The only impact to date is that I seem to need less levo to achieve same blood hormone levels.
This is most likely because oestrogen can block the uptake of thyroid hormones, leading to symptoms of hypothyroidism. TH uptake may have improved with cessation of HRT.....lower dose required!
How much levo are you taking?
I would have thought the endo would have picked this up but perhaps not.
I'm afraid I'm cynical with regards to endo's knowledge...with good reason, like many here!
But suggest you test...
TSH, FT4, FT3, vit D, vit B12, folate, ferritin and thyroid antibodies TPO and Tg
I just had a look at the range for Follicle Stimulation Hormone in post-menopausal women at Brigham in the US healthlibrary.brighamandwom... and it's 19.3 to 100.6 mIU/mL after menopause or slightly higher at Mt Sinai at 25.8 - 134.8 UI/L. The NHS has a slightly lower range (23-116).
If your oestrogen is very low, do you have severe menopause symptoms? There are a lot of overlapping symptoms between hypothyroidism and very low oestrogen. Have you considered HRT? That may be a good starting point. HRT was life changing for me and others I know. It takes effect quickly so you'd know very soon whether your low oestrogen levels are impacting you symptoms.
Thank you for your reply. I was on HRT until June 2023 when I stopped as I had been on it for 7 years. It was for bone protection as I really had no menopausal symptoms like sweats etc.
The only impact to date is that I seem to need less levo to achieve same blood hormone levels.
What are your thyroid hormone levels? Just testing TSH tells you nothing much. Especially if you do have a pituitary or hypothalamus problem - Central Hypo. Unfortunately, the majority of doctors have never even heard of Central Hypo. Because it is considered to be rare - although it's not as rare as all that! - they are not taught about it in med school. And would therefore fail to recognise a case even if it was staring them in the face.
I had oestrogen levels checked by NHS Endo, July 2023 at <92 with a range of 0-504 post menopausal. I have just checked them privately and they are <18.4. From googling , I don't think the NHS are bothered as 0-30 can be expected , post menopausal, even though their range is 0-504 The NHS Endo said they don't believe in HRT!!!!! Unlike you , I have many symptoms of low oestrogen. The NHS Endo refused to check my Progesterone and Testosterone. I have now checked, and I am 470% through the range for progesterone and have many symptoms of high progesterone. I took HRT for over 20 years and it was stopped in August 2022 due to my age.
As DippyDame says, your lower oestrogen levels have improved your thyroid hormone uptake, requiring a lower dose. Low FSH can be an indicator of dysfunction of the pituitary gland. I have a problem with my pituitary too. We are presenting totally differently from one another although we both have pituitary involvement.
I need ALL my female hormone results looked at in relation to one another by a knowledgeable medical professional who is prepared to at least give me some oestrogen to balance out the high progesterone. Someone knowledgeable can pick up possible pituitary dysfunction, and adrenal dysfunction from the levels and interplay of your whole range of female hormones. I doubt the NHS will though.
Hi and thank you for taking the time to reply. I would have liked to continue HRT for my bones but the GP said I should stop as I had been on it for 7 years and she warned about the bc risk. I was too scared to risk it. I had an early menopause at 43 and strong genetic predisposition to osteoporosis. However I really dont want to take the osteoporosis drugs which all sound horrid.
I note that you were on HRT for over 20 years and I am guessing you had no ill effects?
I would have liked to continue too, but NHS mistakenly thinks when you get to 65 you need to come off. I started it originally as was crying if happy, if sad , and no particular reason. I had dreadful period pain as was usual for me, but no period, but kept having to go and change period products as felt I must be flooding, yet my period had stopped, whilst still experiencing the usual pain. Weird! Lots of sweating. I was roughly around 43 when I started it too. It did stop the emotional lability, which I was grateful for, as felt like a complete idiot bursting into tears all the time. Stopped the phantom periods and pain. I still felt ill. Diagnosed 1987 with Chronic Fatigue syndrome/M.E. I had combined HRT , Oestrogen 2mg/Progesterone 1mg. I was getting much needed Oestrogen when on it, but it would also have been giving me more Progesterone which appears to have been something I didn't need. I never, ever had my levels checked before being given it , whilst on it, nor when stopped taking it.
You need to say you have zero libido, apparently they will only provide it for that reason. Any other debilitating symptoms may be ignored, even serious quality of life symptoms. They might consider these as of secondary importance to libido. I think there may be a blanket NHS ban in my area if over 65!!??!
So , no, I wasn't aware of any ill effects from it. Now that I am off it for 2 years, my memory definately impaired and all pubic hair promptly fell out.
Thanks for your reply. I may ask if I can go back on a low dose and see what happens. I'm 61 so might get it for another few years if I'm prepared to accept the breast cancer risk.
Glad to hear that you didn't suffer menopause symptoms Eton and that you had the benefit of bone protection. It's good that you can manage on a lower dose of levo. There are so many variables in this condition. I've taken the advice here regarding selenium and vitamin supplements with good effect and I'll boost my essential amino acids intake and hope for an improvement in fatigue etc. I'm afraid I know next to nothing about the pituitary involvement or where to find reliable advice on it aside from this forum really. Hopefully you'll be steered in the right direction to investigate.
These should have been tested 2-4 months after stopping HRT ….did that happen
What vitamin supplements are you taking
Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
If also on T3 ….day before test split T3 as 2 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
From what I know and read from Menopause specialists Dr Louise Newson and it’s on her Balance app and Website, is our hormones can rollercoaster even on the same day in perimenopause and although you are post menopause I assume this still can give some slight variation too depending on how long you’ve been post menopause or if you were on hrt at time of the test. It isn’t recommended doing a FSH test whilst on hrt. If this was the case the results wouldn’t be right.
There maybe more information on levels post menopausal but regardless they usually only test and use this as guide to give you more or less hrt…if not on hrt it would be normal to have low oestrogen levels.
I have just been on Decapeptyl injections which shut down sex hormones at pituitary so I know pituitary has impact on these hormones amongst others… have you any symptoms of a pituitary gland condition? Were your thyroid hormones low too?
Unfortunately joining the dots isn’t very often done by specialists they just look at the area they’re doing day in day out most endocrinologist deal with diabetes although supposedly specialists in hormones, many will tell you that isn’t the case.. find a good thyroid Endocrinologist is hard.
I expect if diagnosed via GP and on thyroid medication until exhausted all avenues other things won’t be addressed- My experience.
I had 2 pelvic MRIs one orthopaedic one gynaecological why the first MRI couldn’t be thorough enough to give all information so another wasn’t required I don’t know, so I know most consultants just look at their specific areas.
Did you ask your doctor why they measured your FSH in the first place? (FSH to the person who replied with the question, FSH is the hormone which comes from the pituitary gland to stimulate the ovaries during the follicular phase (to create ovulation) and during menopause the ovaries cease to respond, causing the pituitary gland to start screaming at them more loudly by increasing its levels).
FSH used to be drawn regularly to check if women are in menopause. This has gone out of fashion and at least in the US we've returned to just counting months since the last period. After one year of no periods your are in menopause (not to say that it is never checked, of course, if there is suspect vaginal bleeding or something of that sort then where the woman is in her reproductive life becomes relevant).
But I've actually never heard of FSH being checked as any sort of matter of normal operations (ie, unless there's suspicion for something quite weird) in anyone ten or more years past menopause.
Your number is low, but not wildly so. If you are worried about your pituitary gland you could do a test for cortisol levels (they can be off due to either the pituitary or the adrenal gland, but it would be a start-- people without pituitary glands need to take supplements of cortisol type hormones (prednisone, etc) at all times, as well as supplements of all the other hormones which are the end-organ response to pituitary stimulation (IOW, eg, we don't supply TSH, we supply thyroid hormone).
So, my first thing to do would be to ask your doctor why they checked your FSH levels.
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