T Nation

Hormonal Issue, Female

Hi,
I want to ask, I haven’t had period for over 5 months, im 35 F, I have been posting here in the past and I found this forum helpful, so please if you could give me an opinion I would appreciate that. Im 5’5" and 120lb, exercise regulary every day- 30-45 min- either high intensity workout(tabata style) , weight lifting or running, like I said I haven’t had my period for 5 months now and would like to start planning family. My thyroid is under the control, taking cytomel 25mcg and synthroid 100mcg, also metformin 1500mg.

My latest blood test
progesterone 0.5
estradiol 40
FSH 6.8
LH 2.8
Free T3 4.5 normal range 2.3-4.2
Free T4 1.4 normal range 0.8-1.8
TSH 0.01 normal range 0.4-4.5
Reverse T3 20 normal range 8-25
A1C 5.1

The doctor prescribed me Prometrium 200mg for 10 days to induce bleeding.
Any suggestion? I am so afraid to gain weight.

[quote]florida2001 wrote:
I am so afraid to gain weight.[/quote]

Why?

http://www.uptodate.com/contents/exogenous-hyperthyroidism

Please post your waking body temperatures and also mid-afternoon. This will indicate the overall effects of T3 and rT3 on your cells.

I think that you are over-training and that can contribute to increased rT3 levels. Have you lost a lot of fat? That can affect a women’s hormones. If you have lost a lot of fat, that can indicate that one is “hypothyroid”.

I can’t comment on hormone levels. And a doctor would not be able to unless one knew where you were in your cycle. But you are not cycling…

You need estrogens to build up the blood rich lining in your womb and progesterone to prevent bleeding. Then a drop in progesterone allows your period to occur. So it appears that your ovaries are not getting the job done. Your LH/FSH looks normal, but we can’t pin point that to where you are in your cycle. In menopause, FSH can be quite high and you are not there.

Have you had any hot flashes?

Prometrium is bio-identical progeserone. When you take for 10 days then stop, we will see what happens.

Your hormone problems are probably wrecking your libido as well. Are you less emotional now. I understand that you may be very upset by what has happened. Do you feel that you are less caring and empathetic? That can be a result of lower estrogen levels. Low testosterone would also lower sex drive.

my waking temperatures fluctuating between 97.0 - 97.4, in the afternoon 98.0-98.3

my testosterone level was 38 normal range 2-45

also having headaches recently, no libido, but no hot flashes

as far as my exercise routine
M - 30 min high intensity training- tabata style
T- 30 min running
W- 30 min tabata HIIt + sometimes weight training in PM no more than 30 min
Th- 30-40 min cardio
F- 20-30 min HIIT (tabata style)
S- power yoga 75min
Su - power yoga + weight training PM 30 min

With lower body temperatures:

  • you might still have some hypo symptoms, consider body temperature as your dosing guide.
  • with your high T3, you might have rT3 blocking your fT3, lab ranges are only a guide, some will be more adversely affected by rT3
  • fT4–>rT3 is driven by adrenal issues and fT4 levels. You could try a little less T4 and more T3 as fT3–>rT3 never happens

Over training can stress the adrenals and lead to elevated rT3. So can starvation diets. Please read the sticky “thyroid basics” and note references to stress and Wilson’s book “adrenal fatigue”.

For adrenal labs:
DHEA-S
pregnenolone
AM cortisol [at 8 AM or 1 hour after waking up]

  • if lower, [SB >10], follow up with 4 sample salival cortisol test

Please describe your level of stress now and any stress factors in the past that led up to your issues.
Please list all medications now and in past time frame.

  • Rx and OTC
    Any accidents, divorce, job lost, illness or surgeries? - adrenal stressors

If you have adrenal fatigue, your exercise program might be too much.

Please address all questions from my first post.

hi,
to answer questions
no I do not have hot flashes
I dont think Im emotional
yes maybe Im not much emphatetic
I have lower sex drive

I used to take much higer dosage of synthroid, used to be on 200 mcg. When I was on 200mcg synthroid my reverse T3 used to be over the normal range 45. The doctor has slowly has been lowering synthroid and adding cytomel. It took me more than year to balance it, so now Im on 100mcg synthroid and 25 mg cytomel.Feeling Ok, my period has been regular all the time until 5 months ago. Since then I also gained 6 lb.

I didnt do any drastic changes in diet,exercise. The stress level is also about the same.No illnesses,no injuries.

Curently Im on 100mcg synthroid
25mcg cytomel
1500 mg metformin- I belive metformin helped me in past regulate my cycle and fixed acne.

thank you

another thing Im thinking, can the thyroid be suppressed due to low progesterone?

?

Your levels of progesterone would not affect the thyroid levels as you are medicating.

Progesterone is one step away from cortisol. So low progesterone could lead to lower cortisol and adrenal/cortisol problems can lead to higher amounts of rT3. This is an effect of stress, illnesses etc. “Adrenal fatigue” which can have low cortisol levels - progesterone can help.

You say not stressors, but did you get into a starvation diet at some point. Over training does stress the body and the adrenals, especially if you are pushing your system to overcome the effect of your metabolic state.

I am guessing that your rT3 is still high and you then have hypothyroid symptoms, including weight gain, low energy and low temperatures.

T4 did not cause rT3, but with this condition, more T4 leads to more T4–>T3.

I don’t think that you are balanced.

Where to start? Adrenal fatigue is quite complex. What I recommend is that folks read Wilson’s book to see if they find that the book seems to be talking about their life. It might give you some ideas.

You might take a two pronged approach to this. Do some HRT while working on the other issues and then maybe you can resolve things and get off of the HRT later. This would add some normalicy to your life. With HRT, you need estrogen(s) and progesterone. DO NOY use progestins. Finding a doc that can work with this is always the challenge. There are some ideas in the finding a TRT doc sticky that might be useful.

  • HRT
  • more T3 to reduce rT3 to allow fT3 to get into your cells which will boost energy levels and body temperature
  • Wilson’s book to address the adrenal factors that are leading to increased rT3 levels

BTW, I am a retired Engineer. I have always had an interest in these “systems” and they make sense to me. You can do some reading and in many cases will be more informed in these issues than most doctors.

Hi,
Thanks for reply, my rT3 are 20 normal range 8-25 , I used to have 45 and more. So there has been some improvement by suplemmenting with T3 (currently 25 mcg cytomel)

The doctor prescribed me PROMETRIUM 200mg for 10 days. How do you feel about pill form progesterone?

Also, do you think fasting for 16-18 hr could mess up with adrenals. I do intermittent fasting. Intermittent fasting is not a diet, itâ??s a pattern of eating. Itâ??s a way of scheduling your meals so that you get the most out of them. Intermittent fasting doesnâ??t change what you eat, it changes when you eat. So instead of eating 5x day small meal I eat 3 larger meal so I feel satisfied.

[quote]KSman wrote:
Your levels of progesterone would not affect the thyroid levels as you are medicating.

Progesterone is one step away from cortisol. So low progesterone could lead to lower cortisol and adrenal/cortisol problems can lead to higher amounts of rT3. This is an effect of stress, illnesses etc. “Adrenal fatigue” which can have low cortisol levels - progesterone can help.

You say not stressors, but did you get into a starvation diet at some point. Over training does stress the body and the adrenals, especially if you are pushing your system to overcome the effect of your metabolic state.

I am guessing that your rT3 is still high and you then have hypothyroid symptoms, including weight gain, low energy and low temperatures.

T4 did not cause rT3, but with this condition, more T4 leads to more T4–>T3.

I don’t think that you are balanced.

Where to start? Adrenal fatigue is quite complex. What I recommend is that folks read Wilson’s book to see if they find that the book seems to be talking about their life. It might give you some ideas.

You might take a two pronged approach to this. Do some HRT while working on the other issues and then maybe you can resolve things and get off of the HRT later. This would add some normalicy to your life. With HRT, you need estrogen(s) and progesterone. DO NOY use progestins. Finding a doc that can work with this is always the challenge. There are some ideas in the finding a TRT doc sticky that might be useful.

  • HRT
  • more T3 to reduce rT3 to allow fT3 to get into your cells which will boost energy levels and body temperature
  • Wilson’s book to address the adrenal factors that are leading to increased rT3 levels

BTW, I am a retired Engineer. I have always had an interest in these “systems” and they make sense to me. You can do some reading and in many cases will be more informed in these issues than most doctors.
[/quote]

We know from your body temperatures that you are not getting enough fT3 into your cells.

  • do you feel like you still have hypo symptoms other than body temps, libido and weight gain?

I know that rT3 improved, but you need to do more. You have two issues, the adrenal stressors that are the cause and the T4 levels that feed the problem.

With your issues, I don’t understand your ability to do the training that you do. I wonder if you are driving through your medical issues with determination and will power. I have seen this with some guys where they are training hard and I wonder at their ability to function. I suspect that in this situation that there is a lot of cortisol release, one’s built in stimulant.

Some do better on desiccated thyroid products that pharmaceuticals.

PROMETRIUM is a brand, oral progesterone. Progesterone is not very bio-available, so one takes a huge amount, to absorb very little. You can increase absorption by taking with a meal that has fats/oils and not taking with a high fiber meal. This goes for all of your supplements that are hydrophobic, including vitamins D-3, E, CoQ10, DHEA, fish oil

Don’t know what to say about those feeding issues.

I do sense that you are cherry picking the issues that I have raised.

Do you use energy drinks, lots of caffeine or weight loss supplements? Looking for medications or supplements that would wear down the adrenals. Any Rx or OTC meds in the past leading up to your issues?

Back to libido. You could try some small amounts of T cream alone or as part of HRT

Florida,

By reading your description, I’m going to guess several things are going on here.

  1. You aren’t eating enough (and probably not enough fat or protein)

  2. You aren’t sleeping enough

  3. You’re working out too much and too hard

  4. You’re worried about weight (just an arbitrary number) instead of how you look/feel/perform

  5. Please post a day’s diet or at the very least your macro targets for the day. Fats and cholesterol are necessary for the creation of hormones. Dietary fat does not in and of itself make you fat. They are necessary. Eat protein, probably more than you would expect. Shoot for 2 grams of protein for every Kg of body mass. Don’t skimp on the carbs, but appreciate that it’s very easy to over-do them. On days where you’re doing a hard workout, make sure you have plenty of carbs. On day where you’re not doing a lot of high intensity work, you can hold back on them. For god’s sake GET RID OF THE INTERMITTENT FASTING. That’s a tool for someone who is hitting on all cylinders and their body responds well to it. For most people it just causes problems and for anyone who has problems to begin with it will make it worse.

  6. How much do you sleep and what is the quality of that sleep? There’s a reason why they chronically withholding sleep is a torture device. Make sure you sleep 8 hours at a minimum. If you can schedule 10 hours, then do it. Sleep is a very, very good thing and absolutely necessary.

  7. Your workout schedule is too much. Why are you doing all this HIIT? What are your goals? Here’s my quick take on your workout schedule while knowing not much about you.

M - rest…read a book…go to a park and watch birds.
Tu - HIIT workout, sprints are great
W - 60 minutes brisk walk. Carry some hand weights if you want.
Th - Weight training with ‘heavy’ weights (whatever is heavy to you…don’t worry about the actual numbers)
F - 30-40 minutes cardio
Sa - Yoga
Su - Yoga / weights

  1. 5’ - 5" and 120# is skinny and probably a skinny/fat combo. We can change that. First…throw your scales off the closest tall building. If you were to pick up 7 pounds of muscle and lose 2 pounds of fat, you’d be 5# heavier, but you’d probably fit better in your clothes, perform better during your workouts and feel better all the time. On the flip side, if you lost 4 pounds of muscle and gained 2 pounds of fat, you’d be lighter, but have to squeeze into your clothes, perform like crap and feel like hell. Scales are a shitty measure of health and they just fuel a neurosis.

A 5’-5" figure competitor may weigh 20 pounds heavier than you and looks good. The smallest weight class for women in strongman competitions is 140#. Those women look great.

Make performance goals that relate back to your workouts. Take selfies in the mirror (and keep them to yourself). Weight is an arbitrary number, it’s not a goal. It’s just a fall-out number. Once every month compare your selfie picture to see if you like the direction you body change is going. Once every 6-8 weeks, log your performance with your performance goals. This is a much better way to measure progress.

I’ve been in a similar situation as you. It’s not fun, and I appreciate your frustration. You can get on track here and we’ll help you. Good luck!

Hi
thank you, Im also getting the same feeling that something is intefering with my thyroid and the conversion of t4-T3 is not sufficient.

I think I have strong will power to do my exercises every day, sometimes I feel like I have to push myself, but without doing it I would feel like my day is not complete.

I do not use any energy drink, no weight loss suplemments, no Rx other than Synthroid, cytomel and metformin. I take multivitamins and L thyroxin only.
I drink 3 coffes daily (12 oz) usually one or two I mix half decaf half regular

Besides my low body temperature I feel cold during the day- my hands and feet are cold. Gaining weight, no period for 5 months, no sex drive.

What is the best source of iodine? Would it be helpful to add it to my suplemments?

thx

quote]KSman wrote:
We know from your body temperatures that you are not getting enough fT3 into your cells.

  • do you feel like you still have hypo symptoms other than body temps, libido and weight gain?

I know that rT3 improved, but you need to do more. You have two issues, the adrenal stressors that are the cause and the T4 levels that feed the problem.

With your issues, I don’t understand your ability to do the training that you do. I wonder if you are driving through your medical issues with determination and will power. I have seen this with some guys where they are training hard and I wonder at their ability to function. I suspect that in this situation that there is a lot of cortisol release, one’s built in stimulant.

Some do better on desiccated thyroid products that pharmaceuticals.

PROMETRIUM is a brand, oral progesterone. Progesterone is not very bio-available, so one takes a huge amount, to absorb very little. You can increase absorption by taking with a meal that has fats/oils and not taking with a high fiber meal. This goes for all of your supplements that are hydrophobic, including vitamins D-3, E, CoQ10, DHEA, fish oil

Don’t know what to say about those feeding issues.

I do sense that you are cherry picking the issues that I have raised.

Do you use energy drinks, lots of caffeine or weight loss supplements? Looking for medications or supplements that would wear down the adrenals. Any Rx or OTC meds in the past leading up to your issues?

Back to libido. You could try some small amounts of T cream alone or as part of HRT[/quote]

"I have question if iodine would be good choice to add to my supplements? If yes what kind do you recommend? I believe I do have thyroid conversion problem even though my rT3 clear out.

Also any recommendation how to heal adrenals?
"

There are roles for iodine in the body, but not understood. You don’t need it for your thyroid. And your thyroid meds are delivering some iodine. So hard to say. Getting 150-180mcg in a vitamin product should cover your needs.

Heal the adrenals?

I ask specific questions and you don’t respond to them.

[quote]KSman wrote:

I ask specific questions and you don’t respond to them.[/quote]

hi sorry I thought I answered all the questions,

to answer questions
no I do not have hot flashes
I dont think Im emotional
yes maybe Im not much emphatetic
I have lower sex drive

I think I have strong will power to do my exercises every day, sometimes I feel like I have to push myself, but without doing it I would feel like my day is not complete.

I do not use any energy drink, no weight loss suplemments, no Rx other than Synthroid, cytomel and metformin. I take multivitamins and L thyroxin only.
I drink 3 coffes daily (12 oz) usually one or two I mix half decaf half regular

Besides my low body temperature I feel cold during the day- my hands and feet are cold. Gaining weight, no period for 5 months, no sex drive.
I used to take much higer dosage of synthroid, used to be on 200 mcg. When I was on 200mcg synthroid my reverse T3 used to be over the normal range 45. The doctor has slowly has been lowering synthroid and adding cytomel. It took me more than year to balance it, so now Im on 100mcg synthroid and 25 mg cytomel.Feeling Ok, my period has been regular all the time until 5 months ago. Since then I also gained 6 lb.

I didnt do any drastic changes in diet,exercise. The stress level is also about the same.No illnesses,no injuries.

Curently Im on 100mcg synthroid
25mcg cytomel
1500 mg metformin- I belive metformin helped me in past regulate my cycle and fixed acne.

[quote]Fat Boy 33 wrote:
Florida,

By reading your description, I’m going to guess several things are going on here.

  1. You aren’t eating enough (and probably not enough fat or protein)

  2. You aren’t sleeping enough

  3. You’re working out too much and too hard

  4. You’re worried about weight (just an arbitrary number) instead of how you look/feel/perform

  5. Please post a day’s diet or at the very least your macro targets for the day. Fats and cholesterol are necessary for the creation of hormones. Dietary fat does not in and of itself make you fat. They are necessary. Eat protein, probably more than you would expect. Shoot for 2 grams of protein for every Kg of body mass. Don’t skimp on the carbs, but appreciate that it’s very easy to over-do them. On days where you’re doing a hard workout, make sure you have plenty of carbs. On day where you’re not doing a lot of high intensity work, you can hold back on them. For god’s sake GET RID OF THE INTERMITTENT FASTING. That’s a tool for someone who is hitting on all cylinders and their body responds well to it. For most people it just causes problems and for anyone who has problems to begin with it will make it worse.

  6. How much do you sleep and what is the quality of that sleep? There’s a reason why they chronically withholding sleep is a torture device. Make sure you sleep 8 hours at a minimum. If you can schedule 10 hours, then do it. Sleep is a very, very good thing and absolutely necessary.

  7. Your workout schedule is too much. Why are you doing all this HIIT? What are your goals? Here’s my quick take on your workout schedule while knowing not much about you.

M - rest…read a book…go to a park and watch birds.
Tu - HIIT workout, sprints are great
W - 60 minutes brisk walk. Carry some hand weights if you want.
Th - Weight training with ‘heavy’ weights (whatever is heavy to you…don’t worry about the actual numbers)
F - 30-40 minutes cardio
Sa - Yoga
Su - Yoga / weights

  1. 5’ - 5" and 120# is skinny and probably a skinny/fat combo. We can change that. First…throw your scales off the closest tall building. If you were to pick up 7 pounds of muscle and lose 2 pounds of fat, you’d be 5# heavier, but you’d probably fit better in your clothes, perform better during your workouts and feel better all the time. On the flip side, if you lost 4 pounds of muscle and gained 2 pounds of fat, you’d be lighter, but have to squeeze into your clothes, perform like crap and feel like hell. Scales are a shitty measure of health and they just fuel a neurosis.

A 5’-5" figure competitor may weigh 20 pounds heavier than you and looks good. The smallest weight class for women in strongman competitions is 140#. Those women look great.

Make performance goals that relate back to your workouts. Take selfies in the mirror (and keep them to yourself). Weight is an arbitrary number, it’s not a goal. It’s just a fall-out number. Once every month compare your selfie picture to see if you like the direction you body change is going. Once every 6-8 weeks, log your performance with your performance goals. This is a much better way to measure progress.

I’ve been in a similar situation as you. It’s not fun, and I appreciate your frustration. You can get on track here and we’ll help you. Good luck! [/quote]

my makros are around 1300-1500 cal, for example yesterday 140g P, 130g C, 43g F

I sleep 7-8 hr every day
My HIIT routine look like this , this is an example, I usually do 20-30 min, mostly 30 min.

I’m not afraid of weight, I just saying my clothes fits tighter.
I will try work on reducing exercise, like you said I replace some of the days with brisk walk and add more calories and will see what happend.
Appreciate you help

"Besides my low body temperature I feel cold during the day- my hands and feet are cold. Gaining weight … "

So you have hypo symptoms. You can reduce rT3 further by taking a lotless T4 and more T3. Increase T3 and body temps should increase. As rT4 drops, you may need to then reduce rT3. Body temps are the bottom line.

Other things that you need to consider are in Wilson’s book.

Irregular periods are a hypo symptom, so its reasonable to expect that dealing with your thyroid issues may resolve some other things such as your sexual functioning.

Here’s another question for you. What about vitamin D? Do you spend a good chunk of time outdoors getting sun or take any vitamin D?

It’s just my opinion, but I think if you scaled back just a bit on the training, maybe added some calories (on a hard training day, I think you could add 2-400 calories) and improved sleep by a little (even an extra 30 minutes here or there adds up) you would probably see some improvements.

Here’s an observation on training. When you train every day and go ‘high intensity’ too often, most people run into recovery issues. So what you end up doing is not recovering enough to actually go 100%. Now your HIIT is 90%, but it feels like 100, because you aren’t fully recovered. After a while, you can’t recover from that, so you’re down to 80% which still feels like 100. It’s a difficult downward spiral, especially for someone who is really adamant about their training. Sometimes the hardest thing to do is just rest. Crossfit is notorious for burning people out. This is how they do it. Every day is balls(well, eggs…whatever)-to-the-wall and eventually you just can’t recover properly. If you’re a guy you can throw testosterone at the problem, but women can’t really do that.

Anyway, adding a day of rest and trading out one day for a walk(active recovery) is a way to allow you to recover completely before hitting the next HIIT workout. When you do that type of workout, you need to really go all out, but the subsequent rest is every bit as important as the effort. Without one, the other doesn’t matter.

As far as your food macro’s go, I’d say you’re on the right track. You certainly eat more protein than most women and that’s not a bad thing. On days where you’re going for hi-intensity, you can probably pull the Pro down a bit and push the carbs up. On days where you’re resting/active recovery, you can pull some carbs out. 2-2.5 g/kg/day on protein is kind of a sweet spot for a lot of people, though, so it’s good to see you there already. Keep track of things and experiment to find what really works for you.

One last question. How is your overall life/work stress level? Additional stress at work or in life can effect you in a very similar manner to added training stress. If there’s been some sort of change there, it may be having an influence you didn’t account for.

First Thanks you KSman and FatBoy 33

It all make sense what you are saying. I already purchased Wilson’s book and reading it. Make sense that I’m still hypothyroid and by adding T3 and reducing T4 I can work that out.

To answer Fatboy33 questions
I spend lot of time outside, living in Florida…plenty of sun. Appreciate your advices. I definitely will take rest day.
My stress level is about the same, I do not think I am more stressed than usually.