Hello everyone, thanks for having me. I've been reading through a number of your posts and haven't found anyone with the same issues (as yet) so here's my first post. Would love to hear your thoughts and advice on where I should go next regarding HRT.
Quick Background - diagnosed hypothyroid (NOS) in Feb 2003 after the birth of my daughter and having been investigated for subclinical for a few years prior to that). All good on levothyroxine (T4) until Jan 2012 when I had an accident and was consequently diagnosed with fibromyalgia. Ended up bed and wheelchair bound for about 5 years during which I did a lot of research (when my brain allowed) and discovered that my fT3 levels were consistently lower than normal range and suspected poor T4>T3 converter so was given a trial of liothyronine (T3) on top of my T4 and it took a while to find the right levels but it changed my life completely. I was functional again and even managed to start strength training at the gym 3 times a week (which further helped with my pain levels).
In August 2020 (height of lockdowns) my GP (who has been very supportive) prescribed Evorel Sequi for my suspected menopausal symptoms - irregular periods, night sweats, unrefreshing sleep, mood swings, fatigue and brain fog. I seemed to getting on ok with it, most of my symptoms lessened/resolved although I have had non pitting oedema in my hands/ankles along with a puffy face from time to time. By June of this year, my hypothyroid symptoms had returned (having very gradually got worse for at least 18 months looking back now) - fatigue, increased pain, puffy face, brain fog, hair loss and loss of the outer third of my eyebrows. Problem being the cross over in my hypothyroid and menopausal symptoms so hard to tell what is causing which symptoms at times. My thyroid tests showed I was undermedicated - TSH 4.76 (0.27-4.20), FT4 9.1 (10-22), FT3 2.9 (3.1-6.
despite being told that the transdermal HRT shouldn't affect my thyroid function. I increased my T4 and my latest results are now looking better although still not optimal with my T4 20% through the range and T3 54% through the range. I tend to feel best when my T3 is in the top third and T4 about 50% through the range. I'm making minor tweaks in my T4 doses to try to get there but I understand that things may have changed with regards to where I feel best now that my sex hormones are changing.
However, now that my thyroid levels are much better, I seem to be having major issues with the HRT. I had bloods done privately in August through Medichecks and discovered that my oestradiol was very high. I know that blood tests for oestradiol are not very useful as the levels can fluctuate wildly during perimenopause, but it did make me wonder if my initial symptoms were due to my thyroid levels being off so I decide to remove the patch to see how I felt without it.
Blood test 24th Aug
FSH 8.4IU/L
LH 17.5IU/L
Oestradiol 1,139pmol/L
I was ok for about 3/4 weeks and then the initial symptoms started again. Restarted the patches and started to feel better again within a couple of weeks but started to get mild oedema in my ankles/legs again. At my annual review in October, my GP changed me from the cyclical patches to continuous combination patches (Evorel 50 Conti) and that's when things started to go really awry. Symptoms as follows:
Constipation
Difficulty passing urine at times along with bladder and vulval pain (using tampons can be torturous)
Fatigue
Non-pitting oedema ankles/legs
Puffy face
5kg weight gain
Increased allergy symptoms
Lack of appetite
Nausea
Non existent libido
Low mood
Anxiety
Lack of concentration/memory
Increased generalised pain
Non restorative sleep
Return of occasional Benign Paroxysmal Positional Vertigo
When I was getting my thyroid levels checked I thought it might be a good idea to have my my sex hormones rechecked while I was at it. There are 2 sets of results (2nd and 10th November) because of an issue getting some of the results, at which point I was in the luteal phase of my cycle (period started on 13th Nov). Both tests show high prolactin. 1st test shows high LH and FSH. 2nd test shows high oestradiol and testosterone. I'm led to believe that oestradiol meds and being hypothyroid can cause high prolactin - I don't think it's high enough to be pituitary tumour but need to talk to the GP about it next week.
Blood test Nov 2nd
Albumin 36g/L (35 - 50)
SHBG 111nmol/L (27.1 - 128)
FSH 19.2IU/L (1.7-7.7)
LH 29.9IU/L (1.0-11.4)
Oestradiol 1,051pmol/L (82 - 1251)
Testosterone 0.97nmol/L (0.29 - 1.67)
FAI 0.9% (0.2 - 7.1)
Prolactin 1,370mIU/L (102 - 496)
Results 10/11/22
Albumin 38g/L (35 - 50)
SHBG 114nmol/L (27.1 - 128)
FSH ***
LH ***
Oestradiol 1,660pmol/L (82 - 1251)
Testosterone 2.23nmol/L (0.29 - 1.67)
FAI 2% (0.2 - 7.1)
Prolactin 858mIU/L (102 - 496)
The symptoms have got so bad I've had to stop using the patches (now day 6 and symptoms have improved a bit but still there to varying degrees). I know chopping and changing so much won't be helping but I just want to try get some sort of hormonal balance. I believe that it's the progestin in the patches that I'm reacting badly to as the symptoms were less severe, coming and going when I was using it cyclically. I think I'd like to try body identical progesterone as well as oestradiol. Not sure of I'd be better using it cyclically or continuously. I've had a look and it would seem that my options are Utrogestan oral tablets (the vaginal capsules seem to be for fertility issues??) and Bijuve combination oral tablet but I have just done an IgG food intolerance test that shows I have issues with peanuts and soy (along with cows milk, whey and egg!) and am considering cutting them out my diet for a few months to see if my symptoms improve but there is a warning on the Utrogestan capsules saying they contain soya lecithin. Soy products can also cause issues for hypothyroidism. I was wondering if I was also perhaps showing signs of oestrogen dominance and the Bijuve contains 1mg oestradiol (double that of the Evorel 50) along with 100mg progesterone. I feel as if I'm stuck between a rock and a hard place. Having taken so long to get my hormones balanced enough to feel well, perimenopause has thrown everything into turmoil again.
Has anyone here with hypothyroidism and/or food sensitivities had success with the utrogestan capsules?
If you've got this far, thank you so much for reading. I can't speak to the GP until later next week and would love to hear your thoughts and advice on what my next moves should be.
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Topic: Newbie - Would really appreciate your advice and guidance on HRT (Read 1602 times)