I wonder if someone can help me figure something out.
After my youngest was born 5.5 years ago my periods didn't come back for 2 years, due to extended breastfeeding. Since they returned they haven't ever regularised with cycle length varying each time.
Over the 18 months or so my periods have been varying in length, duration, flow, days of spotting... Everything has been different every month.
I recently had a female hormones test that showed below range oestradiol and significantly above range FSH, prompted a perimenopause diagnosis (alongside symptoms).
What I am now trying to work out, possibly pointlessly, is when peri started.
Now I know what they are I've been having night sweats for years. Not frequently but regurarly; once every month or so.
I'm wondering if actually I was peri 3 years ago and all my symptoms were written off as 'having 2 small kids' or if I lumped them all in as thyroid.
I know that it's all one system and a fault in one system has a domino effect and impacts the rest but how likely is it that hypothyroidism brought about an early peri or did being peri bring about the hypo?
I don't really understand how it all works past the very basics but I think it makes a difference to know if I was peri at about 32.
radd & Jamima I'm tagging you because you've helped me try and understand this before but I won't be offended if you're busy.
If periods were regular pre pregnancy , then i assume that rules out peri starting before then .
and we know you have autoimmune hypo ( high TPOab) . which presumably became apparent at some point after the pregnancy. and this is a common time for it to appear .
i was 32 when i had my 2nd kid . and became autoimmune hypo straight after that and was diagnoses and started levo about 4 yrs later .. but for me being hypo didn't bring about perimenopause . i didn't start menopause until yrs later aged 48/49 ish
Not sure how that helps , .. i don't think there's any way to find out really . but just saying in my case having hypothyroidism relatively young didn't bring about a particularly early menopause .
and i think it is more likely that autoimmune hypo at a relatively young age is brought about by having babies, rather than by early peri- menopause.
Antibodies were only checked by me via private bloods as part of my investigations so yes, only became known after the birth of my first, I think. I was told I was 'subclinical' hypo before getting pregnant with the youngest but fuzzy on when the antibodies were found. (All that detail largely irrelevant, anyway. 😂) but yes - after pregnancy!
It's just so frustrating that proper investigations weren't done at the time.
Premature and Early menopause can be autoimmune and there is a higher chance (risk?) of early menopause in those with other autoimmune diseases but I'm really just stabbing in the dark without oodles of money to spend on tests!
Following because I had very high FSH recently with irregular periods. They were regular until I had surgery. I had normal estrogen and progesterone (though hard to say because it really depends on where in your cycle you are, and if your cycle is messed up, how do you know?) But estrogen and progesterone weren't low or anything. Testosterone wasn't high. I am not TTC, but I don't want FSH high because it doesn't seem normal or healthy.
Yeah, that's the problem. If I'm not cycling regularly (I haven't been since 4 months ago when I had surgery), I'm not even sure what day I'm on. And that's really interesting - in the US, we're told to take bloods on Day 21.
Autoimmunity is commonly initiated, or an existing condition reduced/exacerbated during any time of hormonal flux but particularly pregnancy because of the enormous immune changes that naturally take place.
The HPT and HPA are joined by the HPG (gonads) in influencing and being influenced by levels of thyroid hormone. Steroid hormones are mainly synthesised in the adrenal gland and gonads, and lesser so in other tissues, eg adipose tissue, brain, thymus, and all influence the immune system.
The gonads produce oestrogen and testosterone. The hypothalamus secretes GnRH (gonadotropin-releasing hormone) that stimulates LH (luteinising hormone) and FSH (follicle-stimulating hormone) produced in the pituitary gland. LH & FSH activate the ovaries to produce oestrogen that regulate the menstrual/ovarian cycle, and 'inhibin' that inhibits activin that stimulates more GnRH production in the hypothalamus, so forming a negative feedback loop.
Hypothyroidism reduces the synthesis & metabolic clearance rate of these hormones (altering that feedback loop) and the whole metabolism of gonadal steroids. It also increases the TSH (trying to encourage further thyroid hormone) that encourages increased prolactin, commonly known to further inhibit the synthesis and secretion of LH and FSH.
Bianco speaks of hypothyroidism causing alterations in ovarian, uterus and other organs’ thyroid hormone signalling and transporters, and how this impairs further steroidogenesis (processes by which cholesterol is converted to biologically active steroid hormones.)
SHGB (sex hormone-binding globulin) which transports testosterone, dihydrotestosterone and estradiol is reduced with low thyroid hormone meaning a reduction in total circulating steroid levels and an increase in the free fraction. This may not necessarily be seen as elevated levels as the total may be low already or the body will try to excrete or metabolise unwanted high levels into the next hormone in the cascade, eg just as cortisol switches back and forth with cortisone, estradiol switches with estrone, and testosterone with androstenedione (see pic below).
High FSH & low oestrogen seen together with symptoms is the usual gold standard in diagnosing the start of the menopausal journey. However, because hypothyroidism causes irregularities in the HPT-HPA-HPG axis and similar symptoms, and your periods were normal before hand, I think your doctor is right to try correcting thyroid hormone levels and how it is utilised first as this might encourage better levels of sex hormones.
I have never read that sex hormone deficiencies per se causes hypothyroidism, and I think your hypo more likely the consequence of your pregnancies and unrecognised thyroid autoimmune disease. Also possibly common genetic impairments that predispose you to hypo and disclosed at life’s more demanding times.
It will be interesting to see if NDT helps over the next few months.
Pic taken from 'Revisiting steroidogenesis and its role in immune regulation with the advanced tools and technologies' (very science-y) .... nature.com/articles/s41435-...
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