GPs giving me different advice ......

[ilovemyspace]

Would love some opinions please if anyone can help?

I've been on HRT for some years and it's been working well for me.

In March 2023 I was diagnosed with hyperthyroidism / Graves disease and started on carbimazole.
My thyroid levels have more or less stabilised now, but I'm left with symptoms of lack of concentration / feelings of constant PMT / irritability / lack of energy / tiredness.

One GP doesn't want to look at changing my HR prescription and thinks I need to try CBT to manage these symptoms and a second GP thinks I need to slightly increase my dose of oestrogen as the Graves disease may have 'thrown off' my hormone levels.

I've had bad experiences previously in trying to change my HRT medication 😬

I'm just wondering if anyone has tried CBT for their menopause symptoms and if it's worked for them / if they have any advice?

Much appreciated x

Have your hormone levels actually been tested? Any recommendations. made by anyone are just
guesswork if they haven’t

Ask for tests to be done to base recommendations on the results.

Also, Cbt to manage menopause symptoms. Male GP by any chance?

If you can afford it pay to see an endocrinologist. They are better at joining up the dots.

GPs are pedestrian in relation to Graves and the menopause. Useless when considering both.

From the advice you've been given, cbt to manage menopause symptoms is laughable. The gp is clearly someone who hasn't experienced menopause or a difficult menopause. In your shoes, the other GPs suggestion of slightly increasing the oestrogen is what I'd go for initially, if that doesn't help I'd ask to be referred to a specialist.

You say you've struggled previously with changing hrt, was this a different type of hrt (I struggled with the wrong hrt for me) or just higher dose of the same. For me the latter course of action helped with the symptoms you describe.

My guess is that your GP is following the advice from NICE which suggested CBT alongside HRT when appropriate.

This was first announced about a year ago when NICE suggested CBT instead of HRT. There was a huge outcry from medics and last month this was changed (again) to offer CBT with HRT.

The first step with HRT is to increase or decrease the dose or change they type before anything else.

There is no point having your estrogen tested as it's not accurate when using HRT.

Either see another GP, or a private specialist, or push-back and argue with your GP about it.

Hi Ilovemyspace

I am struggling with a probably overactive thyroid/ meno symptoms issue. It's really challenging isn't it?

Have you had your SHBG tested? Hyper thyroid can lead to a high SHBG which can bind up your oestrogen so if your SHBG changed you may now be getting less benefit from the same oestrogen dose.

Adding testosterone can help to reduce SHBG if it is high. A high bSHBG might also be binding up your natural Testosterone.

If you haven't found it already, the Thyroid forum on Health Unlocked is fantastic, there is so much knowledge and advice on there.

I'd ask for a referral to a specialist clinic at the hospital. GPs probably wouldn't know enough about either the menopause or endocrinology to be trusted on this one.

@Jinglehop ·

Have your hormone levels actually been tested? Any recommendations. made by anyone are just
guesswork if they haven’t
Ask for tests to be done to base recommendations on the results.
Also, Cbt to manage menopause symptoms. Male GP by any chance?

Yep, hormone levels have been tested, but tbh don't give much more info than that I'm menopausal .........

And yes, how did you guess it was a male GP 😂

He strongly recommends CBT and is 'a great advocate' apparently - I was very tempted to ask him if he found it had helped with his menopuse symptoms!!

@NeonGiraffe

Yes, it was a completely different HRT - actually I tried 3 different ones and couldn't believe how much I was bleeding/flooding (sorry if TMI) - it was horrendous 😭

Thank you @JinglingSpringbells @RosesAndHellebores - I think you're right and I need to see a specialist x

@Seasidewalker Yes, I've had my SHBG tested and it's apparently within optimal range
and thanks for the tip on Health Unlocked - I tried the forums on there when I was first diagnosed with Graves, but haven't been back in a while, so I may revisit

@slightlydistrac (love your username!) yes, I think I may have to ask to be referred :)

Thanks all for your comments - I was starting to doubt myself and think that maybe CBT would help - even tho I knew deep down it probably wouldn't!

@ilovemyspace that's good news on your SHBG, I'd want to see the numbers though. I was told mine was fine when it was actually out of the higher range! Next enough seems to be good enough these days 🙄

@Seasidewalker
My GP said they don't do hormone tests in menopause 🙄 so I had a hormone test done privately (Randox Health - they're very good and they give you a detailed rundown of all your results)

I'm going to try a topup of estrogen as advised by the 2nd (female) doctor and if it works, I'll go back to my GP and have several words with him .............