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Managing Hypothyroidism Treatment and Hormone Replacement Therapy

Learn how hormone replacement therapy (HRT) can impact hypothyroidism.
Managing Hypothyroidism Treatment and Hormone Replacement Therapy
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Living with hypothyroidism presents its own set of challenges. But, when you add in the complexities of going through menopause, it can feel so overwhelming...enough to make you break a sweat!

When you’re going through the transition from perimenopause to menopause, you may be considering hormone replacement therapy (HRT) to help manage your symptoms. One important consideration is how HRT can affect your treatment for hypothyroidism. In this article, we’ll review a few key points you’ll want to keep in mind before starting hormone replacement therapy.

What is hormone replacement therapy?

Hormone replacement therapy is the treatment of hormonal balances with medications during perimenopause into menopause, and in some cases, for postmenopausal women. You may have also heard HRT referred to as estrogen replacement therapy (ERT) or menopausal hormone therapy.

During perimenopause -- the period before menopause, when it’s been 12 months since the last menstrual period -- estrogen and progesterone levels decline. This decline in estrogen can lead to symptoms such as:

  • Hot flashes
  • Night sweats
  • Vaginal dryness
  • Mood swings, increased risk of depression and anxiety
  • Uncomfortable, sometimes painful sex
  • Dry skin
  • Brain fog and cognitive impairment

Sometimes, these symptoms are mild and go away with time. However, a subset of patients turn to HRT to help relieve persistent symptoms. HRT contains laboratory-made versions of estrogen, progesterone, or a combination of both. These medications help correct imbalances of these hormones. Your provider will determine if estrogen-only or combination estrogen-progesterone therapy is best for you based on your symptoms and other health conditions you may live with.

HRT comes in many different manufactured forms from pharmaceutical companies. The different forms include oral pills, skin patches, and vaginal creams and rings. Examples of HRT medications include:

  • Climara, Vivelle, Vivelle-Dot: estrogen-only patches
  • Divigel: estrogen-only gel
  • Estrace: estrogen-only oral pill and vaginal cream
  • Premarin: conjugated estrogen-only oral pill, vaginal cream, and injection
  • Prempro: conjugated estrogen-progestin oral pill
  • Climara Pro: estrogen-progestin combination patch
  • Activella: estrogen-progestin combination oral pill

Compounded hormone replacement therapy (HRT) is also available and refers to customized hormone formulations tailored to an individual patient’s needs and prepared by compounding pharmacies. Unlike commercially available HRT products, compounded HRT offers custom replacement doses and combinations, allowing for personalized hormone therapy. This customization is particularly beneficial for individuals who require specific hormone ratios or who have sensitivities to certain ingredients found in mass-produced medications. 

Hormone replacement therapy (HRT) can offer significant benefits for managing symptoms related to menopause, such as hot flashes, vaginal dryness, and mood swings, but it also comes with potential risks. One major concern is an increased risk of certain health conditions, including blood clots, stroke, heart disease, and breast cancer. The risks vary depending on factors such as the type of hormones used (estrogen alone or combined estrogen and progestin), the dosage, the duration of therapy, the age when HRT is taken, and an individual’s health history. For example:

  • Estrogen-only HRT may increase the risk of endometrial or uterine cancer in women who have not had a hysterectomy.
  • HRT is associated with an increased risk of blood clots and breast cancer in some patients
  • HRT increases the risk of developing dementia in those over 65 years of age

Additionally, HRT may also lead to adverse effects such as bloating, breast tenderness, nausea, and headaches. It’s essential for individuals considering HRT to discuss their medical history and concerns with a healthcare provider to weigh the potential risks against the benefits and explore alternative treatments if necessary.

There are also side effects and precautions necessary for each HRT medication. And HRT isn’t meant to be a life-long therapy. The general recommendation is to take the lowest dose for the shortest time. 

What is the connection between thyroid hormone and estrogen?

Thyroid hormone and estrogen have a complex relationship.

Estrogen affects the thyroid gland by altering thyroid hormone production, transport, and breakdown. For instance, estrogen can increase the concentration of thyroid-binding globulin (TBG). TBG is a protein that transports thyroid hormones -- T4 and T3 -- throughout the bloodstream. This elevation in TBG levels can alter thyroid hormone levels. In turn, those on thyroid hormone replacement therapy may need to increase their thyroid medication dose.

Excess estrogen can also increase inflammation in the body. This puts people at risk for autoimmune thyroid disorders. Autoimmune disorders occur when the immune system mistakenly attacks healthy cells. In this case, your immune system attacks your thyroid cells.

In addition, estrogen may increase the production of thyroid cells. More thyroid cells may cause thyroid hormone levels to rise.

Are there any concerns with taking HRT while on thyroid hormone medication?

Levothyroxine is a synthetic form of thyroxine (T4) - a thyroid hormone. It is the most commonly prescribed thyroid hormone replacement therapy to treat hypothyroidism. Some patients are prescribed a desiccated thyroid extract drug like Armour Thyroid or NP Thyroid. When managing hypothyroidism with thyroid hormone therapy alongside estrogen-only HRT, there are specific considerations to keep in mind.

Timing of taking medications

For optimal absorption and to achieve normal thyroid function and levels, thyroid hormone replacement medication is best taken on an empty stomach. This can be 60 minutes before your first meal of the day or right before bedtime, at least 3 hours after dinner.

Taking oral medications for HRT too close to your daily dose of thyroid medication can have adverse outcomes for your thyroid health, as these medications can cause impaired absorption. Lower absorption can lead to low thyroid hormone levels. This, in turn, can cause symptoms of hypothyroidism to reappear.

Other formulations of HRT, like patches and vaginal tablets or creams, are far less likely to affect the absorption of your thyroid medication. Ask your healthcare provider about these other formulations if you find it hard to avoid taking oral HRT and thyroid hormone therapy at the same time of day. 

Medication Tip: How you take your medications is as important as when you take them. You should try to be consistent about when and how you take your medications. For instance, don’t flip-flop between taking them in the morning and night or with food and without food. This can lead to inconsistent hormone levels and make it harder for you and your provider to find the right dose for you.

Estrogen dominance

Estrogen dominance occurs when you have high levels of estrogen. This doesn’t mean that your estrogen levels are too high. It could just mean that estrogen is the most dominant sex hormone in your system. Other sex hormones include progesterone and testosterone. Taking estrogen-only HRT can raise your risk of estrogen dominance. As we learned above, estrogen can impact your thyroid hormone levels.

Hypothyroid patients typically need to check thyroid hormone levels more often while taking HRT. Your provider may increase your medication dose based on your thyroid hormone levels. When you stop taking HRT, make sure your thyroid provider knows. They will likely need to adjust your dose of medication if it was changed while you were taking HRT.

Tips for managing menopausal and hypothyroid symptoms

Medications are often prescribed for managing menopausal and hypothyroidism symptoms. But there are natural ways to balance your hormone levels.

Here are five ways to manage menopausal and hypothyroidism symptoms. Keep in mind- these tips are not for everyone. Discuss your plans with your healthcare provider before starting them.

1. Eat a healthy diet

Consume a well-balanced diet. Be sure to incorporate fruits, vegetables, whole grains, and lean proteins. It is always best to limit processed foods and refined sugars. Some foods – like soy products, edamame, and flaxseed– contain phytoestrogens. Phytoestrogens may help relieve menopausal symptoms, including hot flashes. Phytoestrogens may also help prevent bone loss. But you don’t want to overdo it with these foods, as they can sometimes interfere with your absorption of thyroid medication.

2. Get regular physical activity

Participating in physical activity can help manage menopausal and hypothyroidism symptoms. Try to get at least 150 minutes a week of moderate-intensity exercise. Activities could include walking, biking, yoga, or strength training. You should also try to do strengthening and resistance exercises. Regular physical activity helps promote better sleep and can increase bone density.

3. Herbal and dietary supplements

Some supplements may help relieve menopausal and hypothyroid symptoms. But beware: the benefits of supplements are, in some cases, based on anecdotal reports and not high-quality clinical studies. It’s best to get guidance from your healthcare provider to ensure that your supplements are a good fit for your hormonal and thyroid health. 

4. Focus on comfort

Menopause is often associated with hot flashes and night sweats. In contrast, hypothyroidism can cause cold intolerance. Try to wear breathable fabrics and dress in layers. That way, you can easily add or remove layers. The same principle applies to your bedding. Breathable sheets and several layers of light blankets can help you stay comfortable even with a changing body temperature.

5. Get regular tests and check-ups

Regular blood tests can help assess your thyroid hormone levels. If your dose of thyroid hormone is too low, you will likely experience worsening hypothyroid symptoms. On the other hand, if your thyroid hormone dose is too high, you may experience hyperthyroidism symptoms and a racing metabolism. It often requires some trial and error to find the correct dose.

While you don’t typically need estrogen levels regularly measured while on HRT, you should have regular check-ups. As mentioned, the goal with HRT should be to take the lowest dose for the shortest amount of time. By having regular check-ups with your provider, you can better assess your HRT and manage it carefully. 

A note from Paloma Health

Navigating thyroid hormone therapy for hypothyroidism alongside hormone replacement therapy can be a challenge. This is especially true when coordinating care with different healthcare providers.

Ensuring effective communication and collaboration between your providers is essential for your health. The good news is that Paloma Health’s providers have expertise in the treatment of hypothyroidism and resolving the symptoms of perimenopause and menopause.

As a Paloma Health member, you can also access our convenient at-home thyroid hormone testing, which offers the convenience of getting a complete thyroid blood test panel from the comfort of your home. This convenient and innovative test kit gives you a complete picture of your levels of thyroid hormone, including thyroid-stimulating hormone, Free T4, Free T3, and thyroid antibody levels. The Paloma test kit gives you greater control over your health, making it easier to monitor your health efficiently and proactively. 

You can also access Paloma’s hormone-savvy nutritional and health coaching. Paloma coaches are experienced professionals with expertise in hormonal health and nutrition. They can provide expert guidance on dietary changes, lifestyle modifications, and supplement recommendations tailored to managing your health.

Together, your healthcare team at Paloma will customize a personalized treatment plan just for you and provide the highest standard of care to help you achieve your health and wellness goals and an improved quality of life! Learn more about becoming a Paloma Health member today.

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Emilie White, PharmD

Clinical Pharmacist and Medical Blogger

Emilie White, PharmD is a clinical pharmacist with over a decade of providing direct patient care to those hospitalized. She received her Doctor of Pharmacy degree from Massachusetts College of Pharmacy and Health Sciences. After graduation, Emilie completed a postgraduate pharmacy residency at Bon Secours Memorial Regional Medical Center in Virginia. Her background includes caring for critical care, internal medicine, and surgical patients.

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