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estrogen level less than 5!
questionsunanswered posted:
To make a long story short i'm 31 yrs old and have hypothyroidism (auto immune) and for the past year or so I have been feeling very symptomatic although my thyroid levels were normal on Synthroid. My PCP finally referred me to internal medicine due to my recurring complaints of body aches, severe fatigue, and foggy thinking. I had to beg for help! So I see this new dr who ran all sorts of test. The nurse called me the next day to tell me the dr is changing my birth control and increasing my synthroid. My thyroid levels were ok, my TSH was on the low side but she increased my dose (I'm guessing because my T3 Was low normal.) She changed my bcp from Azurette to Yaz because my estrogen level was barely detectable at < 5. I have called several times to hear what the plan is and why my level is so low but she will not give me an answer! I left a message with my obgyn to see what she thought but it might be a while before she can get back with me. What's going on with me? I'm missing work and I have a two yr old who needs her energetic mommy back! Thanks for taking the time to read this I hope it makes sense I hate using touch screens
Jane Harrison Hohner, RN, RNP responded:
Dear questionsunanswered: My best GUESS as to what is going on with your estradiol level is as follows. Both Azurette and Yaz have exactly the same amounts of ethinyl estradiol--20 micrograms. But more importantly, most of our conventional lab tests for estrogen are designed to measure ovarian forms of estrogen (eg estradiol, estrone, or even estriol). Virtually every birth control pill (BCP) contains a synthetic form of estrogen (ethinyl estadiol) and most of our labs do not routinely do tests for this. When one is on a BCP, natural estrogen and progesterone production is suppressed; instead the synthetic estrogen and progesterone are supplied in carefully measured amounts.

There is way more estrogen in a BCP (even low dose BCPs) than in postmenopausal HRT, so there should be plenty of some type of estrogen to treat hot flashes, sleep problems, vaginal dryness and other menopausal symptoms. Bottom line, unless you have malabsorption you should be getting significant amounts of estrogen--but the lab test won't show it. I have to confess, very early in my career I did try to order an estrogen level under similar circumstances!

My area of specialty is "Pelvis World" so I don't have the expertise to give you an exact diagnosis for the body aches, fatigue, and brain fog. You do have a known autoimmune condition. The clinical principal is that if one has a single autoimmune disorder, be alert for others. If you cannot get an answer from your current MDs you might ask them about a referral to a rheumatologist (they do general autoimmune disorders such as lupus).

Gosh I hope your current symptoms will abate as abruptly as they came on. It would be great if the thyroid medication adjustment did the trick. You need your quality of life to be there for your toddler, AND yourself.

In Support,
Anon_6061 responded:
A test for estrogen level isn't accurate when taking birth control pills. As far as Synthroid, it only contains T4. The thyroid is supposed to convert T4 to T3 but in some people, this conversion process doesn't work well. In this case, a natural dessicated thyroid medication which contains T4 and T3 may be more effective in treating hypothyroid symptoms. Some of these meds are NP thyroid (made by Acella), Naturethroid, Westhroid, Armour, Erfa (Canadian).

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