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[Truffles]

I have a few health issues which meant that I couldn't be sure if certain symptoms were due to menopause or something else, so I had some blood tests done.  The progesterone came back out-of-range low, with oestrogen in range but low, according to the doctor's note that came with the results.  I had them done privately, and want to inform myself so I know what my doctor is talking about when I speak to her about starting HRT, and also if there's something specific that I should ask for.

I know this is such a basic question, but I feel lost in all this, not helped by having an incredibly fuzzy brain: as my progesterone is low, should I be asking for something that's weighted more with progesterone than oestrogen?

Edited to add: sorry, I should have said, my last period was two years ago.

For info, my results:

Progesterone 2.4 (5.82-75.9)

Oestradiol 103 (0-505)

Testosterone (total) 0.4 (0.1-1.4)

FSH 142 (25-135)

Prolactin 811 (102-496).

SHBG 134 (17.3-125)

LH 83.5 (7.7-59).

I'm so grateful for any help.

[Marchlove]

Hi Truffles

Welcome to the forum 

It would be helpful if you could  tell us how old you are and what symptoms you experiencing?

Also, have you started on any hrt yet?

xx

[Truffles]

Hi Marchlove, thanks so much for the welcome and for answering.

I'm 56, had my last period almost exactly two years ago, and have never tried HRT for sex hormones, though I'm on treatment for autoimmune hypothyroidism.

Symptoms are hot flushes, vaginal dryness and possibly atrophy - last time I had a smear test, four years ago, they couldn't get the speculum in and sent me away with a course of oestrogen pessaries; when I went back, no problem at all.  I don't sleep well most of the time, though it's not true insomnia. In addition to the hot flushes, I feel very warm most of the time. I also have crushing fatigue, though I've had post-viral fatigue for years and things got worse after I caught Covid, so I don't know if my fatigue is affected by sex hormones or not. My skin is dry and looks like that of a tortoise, and my hair's been falling out for the last two and a half years and is now quite thin.  I think that's about it. 

Oh, I forgot to add that my brain is fuzzy, my mood is pretty low these days, and I'm quick to tears, as well as getting easily irritated (though I've put those down to tiredness).

[Marchlove]

Hi Truffles

Sorry for the delay.
Well from your symptoms and blood results it certainly seems that you could well benefit from Hrt.

My suggestion would be to start low and go slow. A low dose patch might be suggested or oestrogen gel combined with Utrogestan, which is the progesterone component.
If you decide to go with the oestrogen  gel, start with just one pump or even half a pump and keep it at that for quite awhile to see how you go.

Your testosterone is also low, but doctors usually suggest that you get balanced with the other sex hormones first before adding that in.

Your prolactin is high. That can be for a number of reasons including stress when the test was done or even the time of day, so it might be useful to get that retested.
I expect your doctor will discuss that with you but in the meantime here’s a link with some more information.

https://labs.selfdecode.com/blog/prolactin-blood-test/

Quite a lot for you to take on board all at once, so well done for seeking help to progress your return to better health.

Good luck and let us know how you get on.

Mx

[Truffles]

Hi Marchlove,

Thank you so much for taking the time and effort to go through these results and find the very helpful link on prolactin.  I had no idea my testosterone is low, though I understand what you're saying about leaving that to one side for the moment. 

I've tried reading up on sex hormones, but nowhere I've found seems to mention what are good levels (and I know that will obviously be different for different people), so I felt I was groping around in the dark.  You've been so helpful as to next steps.

Off to phone my GP's surgery!

[Wrensong]

Hi Truffles    I see you've had some good advice from Marchlove but just wanted to ask a little about your thyroid status if that's OK?  You say

I'm on treatment for autoimmune hypothyroidism. . . In addition to the hot flushes, I feel very warm most of the time.

Your feeling continually very warm makes me wonder whether your thyroid dose could perhaps be a bit too high?  The high SHBG is another clue that might point to having too much thyroid hormone in your system.  You mention being irritable & I've also found I'm quick to anger if my thyroid dose is too high.  Having too much can also lead to a continually fatigued, burnt out feeling which can be confusing given tiredness is usually associated with too little thyroid hormone. 

I'm sure you know that as we age we often need a lower dose of thyroid replacement than in younger years but as symptoms can change gradually it can be easy to miss what's going on.  I have had to reduce my dose quite a bit compared to what I needed pre-menopause.

I'm not by any means saying I think your symptoms couldn't also be due to sex hormone deficiency, rather that if you haven't had a recent TFT, it might just be worth checking before you start on HRT.  I second what Marchlove says about starting with a low dose & if necessary increasing gradually.  Transdermal methods (patch, gel, spray) are said to be less likely to mess with our thyroid status.
Wx

[Truffles]

Hi Wrensong,

Thank you so much - that’s such a good point!  I actually had thyroid tests done at the same time as the sex hormone ones, but stupidly didn’t include them above.  I think everything looks okay (my TSH is very low, but that’s not unexpected because I take T3 as well as levothyroxine), though if you have any concerns, I’d be very glad to hear. 

TSH <0.01 (0.27-4.2)
FT4  13.3 (12-22)
FT3 5.9 (3.1-6.8

My last Levo dose was taken 25 hours before testing, which was done at 7am, and my last T3 dose, half of my daily dose, was 11 hours beforehand.

And thanks for the warm welcome!

[Wrensong]

Hi Truffles, thanks for the additional info  .  Like you, I'm on T3 as well as T4 & my tests are carried out under the same conditions as yours - i.e. no meds that day until after testing.

Do you feel these results represent what works best for you in terms of thyroid replacement?  I just wonder whether the suppressed TSH with T3 still quite high up the ref range 11 hours after your last T3 dose might indicate that you're on too much cumulatively & that some of your symptoms might be because your metabolism is being driven too hard as a result.

Like mine, your T4 is towards bottom ref range but that's because we both rely on T3 for a substantial part of our replacement.  Personally, though I did best with a low TSH pre-menopause, postmenopause I would feel very unwell with a suppressed TSH & T3 still that high a considerable time after my last dose, given T3's short half.  We are all different though & you will know better than me what works best for you, but maybe something to think about?  It can be so difficult to work out cause & effect at menopause with a thyroid condition in the mix & I think it's further complicated for those of us with a T3 component to our replacement, so I feel for you.  Please come back to me any time (message me if I'm not around) if it might help to compare notes.
Wx

[Truffles]

That’s so kind of you - thank you.  I’ve been wondering today if my T3 may be a bit high, judging by the figures rather than symptoms (and you’ve also made me wonder if running hotter than I used to might be a sign - though quite useful given the price of gas!!).

I know we’re all different, but at the same time I’m fairly new to T3*, so it’s very helpful to hear your experiences, especially the change Pre- and post-menopause.

*I moved to NDT a year ago due to poor conversion, then had to move to T4/T3 a few months back because of finances.

I think I’m going to drop my T3 dose slightly, and I have plenty of room to add in a bit of T4 if I feel I need to in a few weeks.  I’ll still try to get a GP appointment about HRT, because waiting for the appointment will give me time to see if dropping the dose changes anything.  I’ve been having hot flushes and hair loss for at least two years, so those at least are probably not thyroid driven, but it doesn’t mean other things aren’t.

Thanks again for all your help and generous offer.

[Wrensong]

You're very welcome.  Yes, I have a conversion defect too, which is a pain to put it mildly .  I could never get on with NDT & my current Endocrinologist doesn't support its use, but he's collaborative & not dictatorial which is essential for me as I very much need to be involved in decisions about my care. 

I think you're wise to reduce your T3 dose a bit to see how you feel & also because if we're on too much long term it's not good for the body (bones, cardiovascular system, kidneys etc).  You should get an idea quite quickly whether less suits you better because as you'll know T3 doesn't hang around in the system for long, though I think it could take a while for your body to recover fully if you've possibly been on too high a dose for some time.

Although as you say hair loss can be related to sex hormone insufficiency or imbalance, we can also lose hair on the wrong thyroid dose over time.  The skin can suffer too.

It's possible that HRT will have some effect on your thyroid requirement too, so a good idea to do a TFT 6-8 weeks after starting, again after any HRT dose change & of course, any time you suspect things are not right.  As I'm still trying to balance the two, I'm currently having both sex hormone & thyroid levels tested quite frequently, but it does get expensive when the NHS doesn't like to test T3 for hypothyroid patients & we're not what you might call comfortably off  , so I sympathise with what you say about the cost of NDT being a consideration.

Whatever steps you take I do hope you'll feel better soon & that HRT will help.
Wx

[Truffles]

Hi Wrensong,

Sorry to be so long replying to you.  I'm sorry to hear you too struggle with a thyroid hormone conversion issue, but glad you've found an open-minded endocrinologist to work with.

I think the reason I'm hoping that the hair loss might be down to sex hormones is that it was constant even on a much lower thyroid hormone dose.  It's such a pain, this condition, when being either over or under can have identical symptoms!

I'm very grateful for the tip re HRT potentially changing one's requirement for thyroid meds.  I've got some micronised progesterone (can't quite remember the brand name, though it begins with U) and oestradiol gel on the way, so am both hopeful and a little anxious to see how things go.  I'll be following Marchlove's advice and starting low and slow.

[Wrensong]

Hi Truffles, good to know you have some gel & Utrogestan in the pipeline.  Transdermal oestrogen with micronised progesterone is considered the gold standard combination & there's every chance you will do well on it.  Many women do & the beauty of the gel is its flexibility.   It's only natural to be a bit apprehensive about starting any new medication, especially I think for those of us with other chronic conditions.  You will probably find your thyroid levels are not much affected, if at all, by the HRT as the oestrogen is transdermal, but they just might be so it's just something to be aware of & you can then tweak your thyroid dose if need be.

I hope you'll find in time it helps your hair & any other menopause symptoms & yes, do start low as Marchlove suggested & you can then increase the gel gradually if need be, though I'd make any changes with your docs on board out of courtesy, unless they've given you free rein to increase up to a certain point.

Good luck with it & let us know how you get on.
Wx