Add HRT or Change meds?

[Fliplaar]

hi everyone

I could do with some help and advice

For the last year I’ve been on Levothyroxine and a low dose or liothyronine (125mg levo 10 mg lio) and previously to that I was only on levothyroxine for about 5 years (last dose before adding T3 was 137.5 Mg).

At the same time over this last year I noticed different symptoms getting worse which I think is perimenopause, self doubt and anxiety, racing mind especially at night and terrible sleep , (all of these feel like they come and go in waves) that felt different from previous thyroid symptoms. They’ve gotten to the point I think I want to try HRT so I tested my bloods privately first before going to the doctor to make sure my thyroid levels are good because I thought I needed to check them first.

My results showed pretty much the same levels of T4 and T3 as they where before I added T3 via an endocrinologist but my TSH was much lower.

So 2 weeks ago I reduced my levo to 112.5mg and kept my T3 at 10mg to see if this helps my doubts and anxiety as I thought this would be the first thing the doctor does as they’ll want to improve my TSH before they agreed to try me on HRT gel .

I’m wondering though should I have tried stopping the T3 instead?

My oestrogen is low so I know I’m perimenopause too so I know don’t know if it’s the T3 that doesn’t agree with me or if it’s bad timing and it’s my lowering oestrogen that’s causing the symptoms and I don’t know what the best thing to do to help myself.

Dec 24 - TSH 0.07 / T3 5.1/ T4 17 / (oestrodial 194 range 222-854)

Feb 24 ( had started T3 here 2 months earlier) - TSH 0.154 / T3 5.6/ T4 17.4

Dec 23 - TSH 0.485/ T3 5/ T4 15.4

Ranges for all tests - TSH 0.27-4.2 / T3 3.1-6.8/ T4 12-22

any advice much appreciated x

[TiggerMe Ambassador]

Your symptoms tie in with low oestrogen, your thyroid levels look good so I wouldn't be tempted to mess with them, though they might need a tweak once you are on HRT

If your GP is awkward I found a visit to a private menopause clinic really helpful and then they inform the GP what needs prescribing and they take it on

[Fliplaar in reply to TiggerMe]

Thanks TiggerMe that’s a really good idea about the private menopause clinic x

[TiggerMe Ambassador in reply to Fliplaar]

I found it a much easier way to get access to various products and information as my GP wasn't up to speed, when they received the letter from the Meno Clinic they were all scratching their heads as they hadn't even heard of Lenzetto and getting them to supply Testosterone was another battle... but I won in the end and they are better educated now!🙃

[GussyG in reply to TiggerMe]

I second this, if you can afford it, it’s the way to go.

[TiggerMe Ambassador in reply to GussyG]

Luckily I got sorted after the initial meeting and one quick follow up to add testosterone so it needn't be a long term commitment to stay with them

[Fliplaar in reply to TiggerMe]

Yeh going to someone who specialises in menopause seems like a good idea x

[TiggerMe Ambassador in reply to Fliplaar]

It also gives you the confidence to make adjustments once you tune into how your body reacts without all the scaremongering putting the fear into you if you do need slightly more or less than they consider the 'norm' it's very much like thyroid hormones so fine tuning is best done by you 🤗

[GussyG in reply to Fliplaar]

Also I think Newson does payment plans now? I used Naomi Potter (who didn’t), but hopefully other practices will follow in offering better payment flexibility 🤞

[SlowDragon Administrator]

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

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

is this how you do your tests

do you always get same brands of Levo and T3 at each prescription

On a normal day how do you take your T3, as a split dose?

What time are T3 doses?

what are your vitamin D, folate, ferritin and B12 levels

What vitamin supplements are you taking

[Fliplaar in reply to SlowDragon]

Hi Slow Dragon

I do my tests exactly as you’ve just noted. I have been taking 125mg of Levo and 5mg of Lio around 6:30am as advised no food or caffeine just water leave for an hour, and I take my other 5mg of lio at 4pm. Last 2 weeks I’ve reduced my levo to 112.5mg to try to get my TSH up before going to the docs for HRT.

I take only Mercury Pharma for all as that’s the brand that agrees best with me.

I was on 2x 210mg ferrous fumate tablets which I took at 12o’clock and 10pm but I’ve just stopped taking them as the doctor has asked me in for a blood test to check my levels before they renew my prescription. My iron levels on my private test came back as the screen shot above.

I also eat 3 Brazil nuts a day for selenium, I use vitamin D with K2 spray, vitamin c spray, I take a vitamin B complex (super B igennus), a cod liver oil tablet, a probiotic tablet, and a magnesium at night. I also have Vit B shots at the docs every 3 months . My current levels are on a screen shot sent separately .

Thanks

Iron

[SlowDragon Administrator in reply to Fliplaar]

Was CRP tested for inflammation

If you have inflammation ferritin can be false high

Your ferritin is much higher than your iron

Will tag humanbean and FallingInReverse to comment

[Fliplaar in reply to SlowDragon]

is this the same thing?

CRP?

[SlowDragon Administrator in reply to Fliplaar]

Yes

[Tina_Maria]

Your levels before you started reducing your levothyroxine were actually pretty spot on. If you reduced your levels of levothyroxine only to increase your TSH, this will be a futile experiment, as you are still taking T3, so your TSH will be low or very low. And reducing your levo could actually contribute to you not feeling good. I would certainly not stop the T3, as this will not be productive and will make you feel hypothyroid again. If you add HRT in the mix, you do not know what would have had the effect. How do you feel after the 2 weeks on the reduced dose? Have you noticed any difference?

I would be tempted to stay on your original dose for now and then add the HRT. Once you have been on HRT for a while, I would do another thyroid function test. Oestrogen can reduce the amount of thyroid hormones available, so you might have to tweak your medication anyway. As others have suggested, I would see a specialist in menopause and then take it from there.

[Fliplaar in reply to Tina_Maria]

I felt a bit calmer at first on the slightly lower dose , I was worried the docs wouldn’t be able to look past my TSH so thought I’d try and see if it helped and retest before going to the docs and them officially lowering my dose to something that doesn’t work and me struggling to get it out back up x there’s just a lot of moving pieces isn’t there and I didn’t know what to do first x

[Tina_Maria in reply to Fliplaar]

Yes I agree, it can be quite difficult to see what would be the best thing to do, we are all individuals and it can be trial and error. Even though the numbers and results can guide us to where we need to be, how we actually feel with it is much more important than just the naked numbers.

I felt a lot better when starting HRT (well, I had a hot flush nearly every hour day and night!) and it may take a bit of time to get the right application or dose, but it will all be worth it. You will get there!👍😉

[Fliplaar in reply to Tina_Maria]

Thank you Tina Maria for the positive vibes xx

[FallingInReverse]

I’m in a similar place - the only thing I’m curious about vs other replies is if you still have your period.

I know many people here don’t - ie they are in full menopause. This of course removes a huge variable with what HRT we may need.

For me, I’m solidly perimenopausal. Periods every month, although cycle day is a little shifty. I have tested full sex hormones a couple times and am now doing another couple tests making sure those tests are at the right time of my cycle to get actionable insights.

For example - do your symptoms correlate to pre ovulation or post-ovulating weeks? Do you even know if you are still ovulating and do you know when?

For me, I am thinking I have estrogen dominance in the post-ovulating phase. I am testing the week after ovulation and monitoring my symptoms to see if I’m right. Before I took this into my own hands, my gyno wanted to give me a combo pill. But I asked - if I do have estrogen dominance - why would I take a pill with any estrogen at all? She agreed, after being slightly irritated, but is ok with letting me get my blood tests and figure out what I need.

I am still figuring it out and still learning.

I read all these posts with interest to what everyone’s input and see what I’ll ultimately end up doing.

[Fliplaar in reply to FallingInReverse]

I think I’m a little behind you on figuring things out perimenopause wise, but I’m like you in that I have periods but slightly off on the regular cycle front.

I haven’t figured out how it correlates to my cycle yet but I haven’t figured just recently thought it might so was going to start a diary.

I think I’ll probably learn something from you more here than the other way but I hope someone has some extra insight for you here xx

[FallingInReverse in reply to Fliplaar]

I suggest taking your Basel body temperature every morning. Get a 2 decimal thermometer, take temp when you wake up, before you even lift your head up.

Track that. Even plot it in a graph. Tells you incredible things about your monthly cycle in very predictable patterns. Your temp can go up by about a degree when ready to ovulate.

Make a note on that tracking for the day you get your period, and other notable changes in cervical mucous. A key tell of ovulation is change in cervical mucous. It gets slippery. That happens around day 14 after Day 1 of your period. Give or take, but obviously starts getting wonky in peri and stops at menopause.

While you figure things out - use this time to gather data. The above is free, easy, at home, and more informative that you can imagine.

I also decided to get my sex hormone panel a while back even though I had no idea what it all meant. For a baseline.

When my temperature pattern started getting unpredictable and cycle length varied more than usual, I am now getting the sex hormone panel a few cycles in a row at the right time of my cycle so I can confirm what I’m feeling.

All the sex hormones have a relationship throughout the cycle. You cant interpret what results mean unless you know what day if your cycle it was drawn on.

I am just learning. I know many people here go to the Newsom Clinic. I’m in the US so can’t. I also see most of the forum mates posting about this are menopausal. I’m happy to see another perimenopausal person post, and am always in the lookout for more.to see how everyone is managing.

[Fliplaar in reply to FallingInReverse]

I think you’re right, educating yourself helps you feel more equipped to deal with everything going on, and talking to others helps too.

Starting a diary and noting my cycle is where I need to start. Thanks for sharing your thoughts with me x

[sparkly]

My personal opinion would be to start hrt. It was life changing for me as things had become so bad and was causing issues with my T3 medication.I wasn't suffering the normal peri symptoms so no on picked up on it until I saw a private endocrinologist. Who unbeknown to me was a prominent menopause specialist too, she saved me!

I can suggest you start on oestrogel and utrogestan as utrogestan can have a welcomed side effect of being a sedative and giving you wonderful sleep. This is why it's loved by a lot of women, me included. I went from not sleeping till 2/3 am every night to now being knocked out by 10pm and getting 7/8 hours.

Also testosterone was totally life changing for me.

Only started this 3 years ago and changed everything for me. I feel it has played a role in helping with my thyroid in some way. The things it helped with, is what I always blamed on my thyroid. I seem to have really benefited from testosterone and very quickly too. I wonder if it's because of thyroid issues, if testosterone plays a more important part 🤷🏼‍♀️

We all go through perimenopause which can last 10 + before we become post menopause. Some ladies sail through ok with nothing too disrupting but for others it can be debilitating, like me.

I'm a big believer that replacing the hormones that our bodies are slowly, stopping producing is helping our future health as we grow old.

Hrt is said to help and prevent cardiovascular issues, brain and dementia issues, our bones and osteoporosis. I think only in years to come will this be known for sure, but I know I'm staying on it for as long as I benefit from it as the above are all concens for me.

[FallingInReverse in reply to sparkly]

Hi sparkly !

A few questions on your insights and experience also relevant to OP.

Did you start HRT in the middle of peri? Are you now fully meno?

When you say you, and suggest, to start with both oestrogel and utrogestan - did you do a full sex hormone profile? Did you confirm no estrogen dominance? Would that have mattered to you?

Did you dose depending on your cycle day?

When you added testosterone- did you also test before you started.

And do you test sex hormones now with any regularly?

I look forward to your input please thank you 🙏

[sparkly in reply to FallingInReverse]

Hi FIR, yes, unbeknown to me I was in perimenopause and I'm 99.9% sure I'm now post menopause. Only reason I don't know for sure is I started hrt continuously from day one and my periods stopped straightaway.

I can't remember if bloods were tested before starting hrt. I did private test myself a few times once on it but it was as they say.. a roller coaster. One month estradiol would be 180, three weeks later over 2,000 then down too 300 back up to 1,500. Progesterone isn't routinely tested.

In the UK they don't rely on blood tests as a rule, they go off symptoms when prescribing and titrating dose.

Estrogen dominance isn't really spoke about in the UK, and I don't think it is really recognised by nhs.

Progesterone is only prescribed in standard dose. Utrogestan is usually 100mcg regardless of what your estradiol level would be, as this will fluctuate constantly. Or 200mcg if oestrogen is prescribed above licenced dose for extra womb protection.

No, I was started on continuous regimen so had no breaks for a bleed 🎉🥳🍾🥂😃 . This is not the norm in the UK and nearly all ladies still having periods are started on cyclical regimen.

Yes, bloods were taken, but should only be to check testosterone is not already high. It's very difficult to get prescribed testosterone in the UK. Not all areas in the UK are allowed to prescribe it, and not all nhs menopause specialist agree to prescribe.

I have tested my sex hormones recently as my last nhs test showed my oestradiol was dropping. I am going to address with gp as concerned about level not being adequate for brain, bone and cardio health.

I've had really good, speedy nhs treatment for peri/menopause dealings, not everyone dose sadly

[FallingInReverse in reply to sparkly]

Big big thanks sparkly!!!!!!!

[Fliplaar]

thanks sparkly for taking the time talk about everything x

It’s definitely debilitating me so I’m going to go see my doctor and ask for HRT , thanks for your insight on the different types.

Your private Endo wasn’t any where near the northwest of England by any chance?

[sparkly in reply to Fliplaar]

Hi, yes I'll PM you her name, but I know she wasn't taking on new patients till middle of the year