Alison's story

Hormones in a muddle and I’m in a muddle!

'The journey through menopause isn't an easy one but layer in thyroid disease and it certainly makes it more complicated.'

This is not the first time I have written a piece from a patient’s perspective. Looking back at my article from 2020, my last words were ‘From time to time my thyroxine dose needs to be adjusted to keep me on the straight and narrow but apart from the looming menopause my hormones seem to be in check for the time being!’

My thyroid journey has been hyperthyroidism and radioactive iodine treatment – as a result, very little of my thyroid gland, if any, is still active. Therefore the majority of my thyroxine comes from replacement levothyroxine tablets.

On reflection, I suspect perimenopause had been rumbling in the background for some time, maybe even years, and possibly in the early years post hyperthyroidism diagnosis in 2013. Although how would you know when so many of your symptoms relating to thyroid disorders are similar to menopause symptoms?

It is impossible to pinpoint a time when I felt my body was starting to transition into menopause. I know I visited the doctor on a number of occasions over a couple of years to discuss symptoms that were attributed to perimenopause. As someone who has a background in science, it was hard to get my head around why the doctors couldn’t definitively say whether it was perimenopause. What was clear was that perimenopause/menopause could not be discussed without reference to my thyroid function and levothyroxine dosing. During this period, blood tests highlighted a downward trend in my TSH (Thyroid Stimulating Hormone) levels indicating something was changing in my body.

I seemed to be managing the symptoms of perimenopause. Then in early 2022, I started waking in the night with sweats and before long I was having multiple hot flushes throughout the day and night. Further thyroid function tests highlighted that my TSH was now not detectable. This raised concerns and I was referred back to the endocrinology team at the hospital who are still managing my care as I write.

The symptoms of menopause became so significant that, sleep-deprived and tearful, I eventually went back to the doctor to ask for help. We decided to give HRT a try and so began sequential oestrogen and progesterone treatment. Not long after starting, the hot flushes abated and I was enjoying a good night’s sleep. This confirmed that this time, the sweats were due to menopause and not thyroid function. What didn’t correct though was my blood thyroid level.

The endocrinologists have been adjusting my levothyroxine dosing over the last year by gradually reducing the dose. Each adjustment has been followed by a six-week period before retesting my bloods. Finally, my thyroid levels have come back in range.

I am very grateful for the care I have received, as it was only when I started to feel better through a combination of HRT and levothyroxine dose changes that I realised how out of sorts I had been feeling. I didn’t feel physically ill although I am sure the endocrinologists would disagree as prolonged out-of-range thyroid levels have been linked with some long-term physical health problems, including osteoporosis and atrial fibrillation.

For me, it was more my psychological wellbeing that had suffered. Looking back I felt that life had been like climbing a sand dune; hard work and not really achieving anything very easily. The days sped by and family members kept saying “Please slow down”. My hormones were in a muddle and I was in a muddle! Thankfully calmness resumed.       

Just when I thought the story was over, my HRT was changed to continuous dosing of oestrogen and progesterone. I felt quite anxious about yet another change in hormones. It turns out this change didn’t suit me and I had to stop HRT for a period. Six weeks in and I decided to see if I could cope without HRT altogether. Since stopping HRT I have had a routine blood test and endocrinology appointment. This has highlighted that my TSH level has once again reduced but currently is still in range. I am not a medic and therefore will leave the science behind this for the specialists to explain but basically, the falling oestrogen levels have meant that there is more thyroxine circulating in my system. Time will tell if my levels stabilise while still in range and if I remain well!   

The journey through menopause isn’t an easy one for many but layer in thyroid disease and it certainly makes it more complicated. My journey through perimenopause and menopause hasn’t been a short one and I’m not quite there yet. It will be a relief to be out on the other side.   

Our bodies are a delicate balance and when that balance is tipped it can make us feel really out of sorts and in a muddle. I’m sharing my story to let you know you are not alone on this journey.

BTF comment

Alison’s experiences illustrate the array of symptoms, both physical and psychological, some midlife women undergo. When peri/menopause comes on top of an existing thyroid disorder, this can add a further burden to women. So, optimising both hormone conditions is crucial.

Read more about thyroid and menopause

Read Alison's journey with hyperthyroidism

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