Polycystic Ovary Syndrome (PCOS)

Introduction

Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a hormonal disorder that women can get during their childbearing years (ages 15 to 44).  Women with PCOS  produce an excess amount of male hormone (androgen), that are usually present in women in small amounts.

The extra male hormones disrupt the menstrual cycle of a women, hence, women with PCOS get fewer periods than usual. This hormone imbalance can affect your ability to have a child.

What is PCOS?

PCOS affects a woman’s ovaries and ovulation. Ovulation occurs when a mature egg is released from an ovary. This happens so it can be fertilized by a male sperm.

But in PCOS, many small cysts (fluid-filled sacs) can develop inside the ovaries. These sacs are actually follicles, each one containing an immature egg. The eggs never mature enough to trigger ovulation. Due to lack of ovulation, the androgen (male hormone) levels in women with PCOS are higher than usual.

As a result, the excess male hormone levels can cause more problems with a woman’s menstrual cycle and makes it harder for them to get pregnant.


The 3 main features of PCOS are:

  • Irregular Periods: which means your ovaries do not regularly release eggs (ovulation).
  • Excess male hormone (Androgen): excess levels of male hormones may result in physical signs, such as excess facial and body hair (hirsutism), and occasionally severe acne.
  • Polycystic ovaries: your ovaries contain many fluid-filled sacs (follicles) that surround the eggs. As a result, your ovaries might fail to function regularly.

Please note, if you have at least 2 of these features, you may be diagnosed with PCOS.


Furthermore, PCOS also cause hair growth on the face and body and it can contribute to long-term health problems like diabetes and heart disease.

Who gets PCOS?

Most women find out they have PCOS in their 20s and 30s, when they have problems getting pregnant and see their doctor. But PCOS can happen at any age after puberty.

You may be more likely to have PCOS if you have obesity or if you have a mother or sister with PCOS.

What Causes PCOS?

The exact cause of Polycystic ovary syndrome (PCOS) is not clear. Most experts think that several factors play a role include:

  1. Insulin resistance: Insulin is the hormone produced in the pancreas that allows cells to use sugar from foods for energy. But many women with PCOS have insulin resistance, meaning that their body’s cells can’t use insulin properly.

    When cells can’t use insulin properly, the body demand for insulin increases. As a result, your insulin levels become higher than normal. Further, excess insulin might increase androgen (male hormone) production, causing difficulty with ovulation.

    Kindly note, Overweight or Obesity are major causes of insulin resistance in a women. Over time, both obesity and insulin resistance can increase your risk to type 2 diabetes.
  2. Excess androgens: Women with PCOS have high level of androgens (male hormone) than normal. Higher androgen levels in women can prevent the ovaries from releasing an egg (ovulation) during each menstrual cycle, and can cause extra hair growth and acne.
  3. Inflammation: Research has shown that women with PCOS often have a increased levels inflammation in their body, that stimulates polycystic ovaries to produce androgens (male hormone).
  4. Family History: PCOS may also run in families. You might be more likely to have PCOS if your sister or mother also has it.

Symptoms of PCOS

Symptoms of PCOS often develop around the time of the first period. But some women discover they have PCOS, when they have gained a lot of weight or when they have trouble in getting pregnant.

The symptoms of PCOS may include:

  • Irregular periods: The most common PCOS symptoms are missed, irregular, infrequent or very light periods. Some women with PCOS get fewer than eight periods a year.
  • Infertility: Difficulty getting pregnant as a result of irregular ovulation or failure to ovulate.
  • Too much hair: More than 70 percent of women with PCOS grow hair on their face and parts of their body. Excess hair growth is called hirsutism.
  • Acne or oily skin.
  • Weight gain, especially around the belly.
  • Darkening of the skin: Dark or thick patches of skin can form on the back of the neck, in the groin and under the breasts.
  • Male pattern baldness: Thinning hair or hair loss on the scalp.

Effects of PCOS

Women with PCOS are more likely to develop certain serious health problems. These include:

  • Infertility: To get pregnant, you have to ovulate. Women who don’t ovulate regularly don’t release as many eggs to be fertilized. Therefore, PCOS is one of the leading causes of infertility in women.
  • Pregnancy complications: PCOS can also cause problems during pregnancy for you and for your baby. Women with PCOS have higher chance of miscarriage and premature birth.
  • Metabolic syndrome: It is a group of health issues including high blood pressure, high blood sugar and abnormal cholesterol level. Together, these factors are called metabolic syndrome and they increase your risk of heart disease, diabetes, and stroke.
  • Sleep apnea: Women with PCOS, particularly when they are overweight, can be at an increased risk of developing sleep apnea. In this condition your upper airway is obstructed during sleep. This leads to repeated pauses in breathing during the night, which interrupt sleep.
  • Endometrial cancer: Regular periods help to prevent excess thickening of the lining of the uterus. Not having regular periods can lead to abnormal cells building up inside the womb.

    Women who have had absent or very irregular periods (fewer than 4 periods a year) have a higher risk of developing cancer of the womb lining (endometrial cancer).
  • Gestational diabetes: It is a type of diabetes that happens only during pregnancy. Women with PCOS are at greater risk for developing gestational diabetes. This risk increases if you are overweight.

    Usually gestational diabetes goes away after your baby is born. However, you still remain at a higher risk of developing type 2 diabetes after pregnancy, so monitoring and prevention are very important.
  • Depression and Anxiety: The symptoms of PCOS like unwanted hair growth can negatively affect your emotions and confidence. Many women with PCOS end up experiencing depression and anxiety.

How is PCOS diagnosed?

There is no single test to diagnose PCOS. Your doctor will start by asking about your medical history and symptoms. You may be diagnosed with PCOS if you have at least two of the following symptoms:

  1. Irregular periods: Including periods that come too often, not often enough, or not at all.
  2. High androgen levels: Higher than normal levels of androgens in blood.
  3. Cysts in the ovaries: Multiple cysts on one or both ovaries.

In addition, your doctor may also ask whether you have symptoms like:

  • Extra hair growth on your face, chin, and body.
  • Acne.
  • Weight gain.

Apart from your symptoms, your doctor might recommend following mentioned different tests:

  • A pelvic exam: Your doctor visually and manually inspects your reproductive organs for signs of extra male hormones (for example, an enlarged clitoris) and check to see if your ovaries are enlarged or swollen.
Pelvic Exam
Pelvic Exam
  • Ultrasound: This test is used to look at the size of the ovaries and see if they have cysts. The test can also look at the thickness of the lining of the uterus.
    For this, a device (transducer) is placed in your vagina. This device uses sound waves and computer screen to examine your ovaries for cysts.
Transvaginal Ultrasound
Transvaginal Ultrasound
  • Blood Tests:  Your blood may be analyzed to measure the levels of Androgens Hormone (Male Hormones). Your health care provider may also check your blood glucose levels and cholesterol levels.

How is PCOS treated?

There is no cure for PCOS, but the symptoms can be treated. Treating symptoms of PCOS depends on a number of factors such as your age, how severe your symptoms are, and your overall health. The type of treatment may also depend on whether you want to become pregnant in the future. Therefore, speak to your doctor or health care provider about medications for the treatment.

Furthermore, treatment for PCOS usually starts with lifestyle changes like weight loss, diet plan and exercise.

Healthy eating habits and regular physical activity can help relieve PCOS related symptoms. Losing just 5 to 10 percent of your body weight can help regulate your menstrual cycle and improve your chances of getting pregnant. Moreover, losing weight may also help to improve your cholesterol levels, lower your blood glucose levels and help your hormones reach normal levels.

A few studies have found that 30 minutes of moderate intensity exercise at least 4 days a week can help women with PCOS lose weight. Losing weight with exercise also improves ovulation and insulin levels.

Please Note, exercise is even more beneficial when combined with a healthy diet.

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Menopause

Symptoms of Menopause

Menopause is the time in life when your monthly period stops. In other words, it is the permanently end of your menstrual cycles. It is diagnosed, when you have not had a period for one year. Menopause happens because the function of your ovaries stops. As a result, no hormones (estrogen and progesterone) are produced by your ovaries, which control your period and the release of eggs.

Menopause is a natural biological process. It usually begins between the ages of 40 and 55, but can develop before or after this age range. There is no reliable lab test to predict when a woman will experience menopause.

Furthermore, menopause is not a health problem. However, hormonal changes and other factors can cause uncomfortable symptoms, such as hot flashes and weight gain.

Stages of Menopause

Did you know that, natural menopause is not just one phase, it is actually divided into three stages:

  • perimenopause
  • menopause
  • postmenopause

Stage 1- Perimenopause : This phase usually begins several years before menopause, when your ovaries slowly make less estrogen. In the last 1 to 2 years of this stage, the estrogen levels fall faster. Moreover, perimenopause can start up to 10 years before you enter menopause. It often begins in your 40s, but some women enter perimenopause in their 30s.

During perimenopause, your period may become more unpredictable. It may even stop for several months and resume. It’s important to note that you can become pregnant during perimenopause by taking medicines directed by your doctor.

Stage 2- Menopause: The definition of menopause is not having your period for 12 months. At this stage, your ovaries have stopped releasing eggs and reproductive hormones (estrogen and progesterone). Menopause is diagnosed when a woman has gone without a menstrual period for 12 consecutive months.

Stage 3- Postmenopause refers to the years after menopause has occurred. In other words,  postmenopause refers to women who have already reached menopause.

As you enter postmenopause, it’s a good time to reevaluate your health situation and talk to your doctor about long-term health goals. Because, your lower level of estrogen due to postmenopause, puts you at increased risk of heart disease, osteoporosis and other conditions of the heart and bones.

Causes of Menopause

A woman is born with all of her eggs, which are stored in her ovaries. Her ovaries also make the reproductive hormones estrogen and progesterone, which control her period (menstruation) and the release of eggs (ovulation). Menopause happens when the ovaries no longer release an egg every month and menstruation stops.

Age is the most common factor that cause menopause. As you approach your late 30s, your ovaries starts loosing their ability to produce hormones (estrogen and progesterone). Hence, your fertility declines.

In your 40s, your monthly periods may become longer or shorter, heavier or lighter, and less frequent. By the age of 52, the function of your ovaries stops. As a result, no hormones are produced and no egg is released by your ovaries, and you have no more periods.

However, some women can go through menopause in early age. It can be the result of surgery, like if their ovaries are removed in a hysterectomy, or damage to their ovaries from chemotherapy for cancer.

What are the symptoms of Menopause?

Menopause is the time in a woman’s life at which she can no longer reproduce. Symptoms of menopause vary from woman to woman. However,common symptoms of menopause include:

  • Sleep Disturbances: You may have insomnia— trouble falling asleep or staying asleep.
  • Vaginal changes: The lining of your vagina may become thinner, drier, or less stretchy. This can cause dryness or discomfort during sex.
  • Weaker bones: Your bones will probably weaken during menopause. If it’s really bad, it can lead to osteoporosis after menopause.
  • Mood changes: Hormone changes can make you feel anxious, irritable, and tired. Your sex drive might change, too.
  • Night sweats: Hot flashes that wake you up in the middle of the night.
  • Hot Flashes: A hot flash is a sudden, sometimes intense feeling of heat that rushes to your face and upper body.
  • Urinary tract infections (UTIs): You may have to pee more often or get more frequent urinary tract or bladder infections.
  • Weight gain: Hormonal changes that occur during menopause often contribute to weight gain. Many studies have confirmed that women in menopause are likely to gain weight and have larger midsections than women who have not gone through menopause.
  • Depression
  • Anxiety
  • Memory problems
  • Reduced sex drive
  • Dry skin, mouth, and eyes
  • Sore or tender breasts
  • Headaches
  • Racing heart
  • Reduced muscle mass
  • Hair thinning or loss
  • Increased hair growth on other areas of the body, such as the face, neck, chest, and upper back

Please note, women affected with symptoms of racing heart, urinary changes, headaches, or other new medical problems should see a doctor to make sure there is no other cause for these symptoms

How is Menopause diagnosed?

A blood test known as PicoAMH Elisa diagnostic was approved by the U.S. Food and Drug Administration (FDA). This test is used to determine whether a woman has entered menopause or is getting close to entering menopause. The test measures the amount of anti-Müllerian hormone (AMH) in the blood.

AMH is a hormone produced by a woman’s ovaries that has a role in egg release (ovulation). AMH levels fall as menopause approaches and is one of several indicators.

Furthermore, this test may be helpful to women who show symptoms of perimenopause, which can also have bad health impacts. Early menopause (before the age 45) is associated with a higher risk of osteoporosisheart disease, vaginal changes and loss of libido, and mood changes.

Kindly note, your doctor can also order another blood test that will measure the level of certain hormones in the blood, usually follicle stimulating hormone (FSH). FSH is a hormone produced by the pituitary gland. However, this test can be misleading during the beginning of menopause, because, your hormone levels are fluctuating up and down daily. 

Therefore, most doctors will diagnose menopause based on your symptoms, medical history, and menstrual information.

Menopause Treatments

Many women do not need treatment for their menopause symptoms. You may find that your symptoms go away by themselves. However, you may need treatment if your symptoms are severe or affecting your quality of life. Treatments may include:

  • Hormone therapy (HT): This therapy helps to control your symptoms of menopause (such as hot flashes and vaginal dryness). In Hormone therapy, the balance of your body’s hormone levels is maintained by providing supplemental hormones (estrogen and progesterone).

    However, using HT may increase the risk of developing certain diseases and health conditions. A person should not use hormone therapy if they have risk factors for the following health problems, or if they have a personal or family history of these issues:
    • heart disease
    • blood clots
    • gallbladder disease
    • liver disease
    • stroke
    • breast cancer

Furthermore, hormone therapy is available in various forms, including, oral (pill), skin patch and spray. But, it is important to discuss the benefits and risks of hormone therapy with your doctor before using it.

  • Vaginal estrogen: To relieve vaginal dryness, estrogen can be applied directly to the vagina using a vaginal cream or tablet. This treatment releases just a small amount of estrogen, which is absorbed by the vaginal tissues. It can help relieve vaginal dryness.
  • Low dose of antidepressants:  A low dose of certain antidepressants may be useful for management of hot flashes in menopause.
  • Medications for osteoporosis: Depending on individual needs, doctors may recommend medication to prevent or treat osteoporosis (a bone disease).
    Several medications are available that help to reduce bone loss and risk of fractures. Your doctor may prescribe vitamin D supplements to help strengthen bones.
  • Low dose of birth control pills: Oral contraceptive pills are another form of hormone therapy often prescribed for women in perimenopause, to treat irregular vaginal bleeding, relieve hot flashes, vaginal dryness and mood changes.

    Oral contraceptive are not recommended for women who have already reached menopause.

Kindly note, before deciding any form of treatment, talk with your doctor about the risks and benefits involved with each option of treatment. Review your options yearly, as your needs and treatment options may change.

Natural treatments for Menopause symptoms:

  • Soy: Soy has isoflavones, which are phytoestrogens (plant estrogens). Some studies have observed that soy may be effective in reducing menopausal symptoms. However, other studies have found no benefit. Only food forms of soy, like tofu and soy milk, are recommended. Soy in tablet or powder form is not advised.

    Moreover, many experts recommend that women who have a history of breast cancer avoid phytoestrogens.
  • Vitamin E: Topical vitamin E oil applied to the vagina helps to improve lubrication and may also reduce hot flashes.
  • Calcium and Vitamin D: Take calcium and vitamin D supplements to help reduce your risk for osteoporosis (a bone disease). Talk to your doctor about supplements that can help you for your individual health needs.
  • Flaxseed: Flaxseed has omega-3 fatty acids and lignans, which act as phytoestrogens. Results from studies have been mixed, but it may help to reduce menopause symptoms in some women.

    Avoid whole flaxseed because it is difficult to digest.
  • Exercises: It is important to exercise for 20 to 30 minutes a day.

Exercise can help:

    • increase energy
    • promote a better night’s sleep
    • improve mood
    • promote your general well-being

Lifestyle tips for Menopause

Tips for managing the symptoms of menopause include:

  • Practicing relaxation and deep breathing exercises.
  • Having a healthful diet that includes plenty of fresh fruits, vegetables, and whole grains.
  • Quitting smoking.
  • Limiting the intake of alcohol.
  • Good sleeping habits and getting plenty of rest.
  • It is important to do regular exercise for managing the symptoms of menopause.
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Thyroid and Hair Loss

Thyroid and Hair Loss

Thyroid is a small gland which has the shape like a butterfly that sits low on the front of the neck. It helps to regulate many body functions by constantly releasing a steady amount of thyroid hormones into the bloodstream.

The important hormones produced by thyroid gland are thyroxine (T4) and triiodothyronine (T3)

Furthermore, thyroid conditions occur when your thyroid gland is not producing enough hormones Or producing too much of hormones. The most common type of thyroid conditions are as following:

Both conditions (Hypothyroidism & Hyperthyroidism) can cause dry, brittle hair or thinning hair on your scalp and body.

Thyroid conditions can cause hair loss if they are severe and left untreated. But, before understanding how these conditions cause hair loss, let us first understand the hair growth process.

  1. Hair starts growing from the roots (bottom of your hair follicles) on your scalp.
  2. Your scalp’s blood vessels provide nutrients to the root and help in hair growth.
  3. Hair pushes up and out through your skin. The hair passes through the oil glands that help maintain the required moisture in the hair.
  4. Hair grows for sometime and then falls off as a new hair growth cycle starts.

Kindly note, the thyroid hormones (T3 and T4) directly affect hair growth and its development. When the hormone production is disturbed, it can lead to hair thinning across your scalp and other areas such as your eyebrows.

Hair loss due to Autoimmune thyroid disease

Most people with Hypothyroidism or Hyperthyroidism have autoimmune thyroid disease. If someone has one type of autoimmune disease, he/she is more likely to develop another autoimmune condition for example: 

Alopecia areata: Alopecia areata is an autoimmune condition that causes hair loss in people having autoimmune thyroid disease.

It causes circular patches of hair loss in more discrete areas. In most cases this is temporary and does not progress, but unfortunately it can cause significant baldness. 

There are other rare autoimmune conditions that can also cause hair loss :

Hair loss due to Antithyroid Drugs

Some antithyroid drugs such as (carbimazole and propylthiouracil) can, in rare cases, cause hair loss. But, it may be very difficult to tell whether the drug or your thyroid condition is causing hair loss.

Furthermore, it is very rare for anti-thyroid drugs or treatment to cause hair loss. Kindly note, Antithyroid drugs are used to treat an overactive thyroid (Hyperthyroidism).

Slow and gradual thinning of hair is the most common symptom of thyroid related hair loss. You may notice more than usual hair lose while combing.

Furthermore, hair loss may develop slowly with hypothyroidism and hyperthyroidism. You won’t necessarily see patches or bald spots on your scalp, but, your hair may seem thinner all over.

In most cases, hair loss caused by thyroid conditions is temporary, but regrowth of hairs may take several months.

It is important to note here that, you can still experience hair loss even after starting medicines for your thyroid condition. This is because the hair growth cycle is a months long process. But some people start wrongly blaming the thyroid medicines for hair loss. Unfortunately, if they stop their thyroid medicines, the hair loss problem will become worse.

Kindly note, it is perfectly normal to lose 50–100 hairs from your head each day. However, hair loss beyond this needs medical attention and may be related to thyroid problem.

Dear Reader, always remember that, “Treating thyroid related hair loss requires treating the Thyroid Problem“.

Working with your doctor to keep your thyroid disorder under control with medication may keep your hair thicker and can regenerate hair growth. But try to be patient because, regrowth of hairs can be unpredictable and may take several months.

Treatment for an underactive thyroid – (hypothyroidism):

  • levothyroxine: Your doctor will usually prescribe a synthetic hormone called levothyroxine to treat an underactive thyroid (hypothyroidism).

    This medicine is given when your thyroid gland does not produce enough of this hormone on its own.

Treatment for an overactive thyroid – (hyperthyroidism):

  • Antithyroid medications: Antithyroid medications, such as (propylthiouracil and methimazole) decrease the thyroid gland’s ability to make the thyroid hormone. It is used to treat overactive thyroid (hyperthyroidism).
  • Radioactive iodine: This treatment kills some cells in the thyroid gland and reduce the amount of hormones that the gland produces. This treatment induces hypothyroidism, which is then managed by using thyroid hormone replacement therapy for the rest the life.
  • Surgery: Your doctor will monitor your thyroid levels while you are on medication. In some cases, surgery may be necessary. It involves the removal of some or all of the thyroid gland, which may lead to hypothyroidism.

Kindly note, with the treatment, hair growth may be noticeable within several months. But be aware that the new hair may differ in color or texture from your original hair.

Along with medication suggested by your doctor, you may try different home remedies to slowdown hair loss or regenerate hair growth. While the home remedies given below do not hold any scientific evidence, but you can give them a try to boost your hair growth.

1. Eating a balanced diet can help in growth and improve the condition of your hair. Foods that can increase the chances of having healthy hair include:

  • Fish: Oily fish contains omega-3 fatty acids that can help prevent a dry scalp.
  • Green vegetables: Vegetables such as spinach have high levels of vitamins A and C. These vitamins can improve the condition of hair.
  • Protein rich foods: Eating foods rich in protein can help prevent weak hair. Dairy products, nuts and lean meats all contain high levels of protein.
  • Calcium rich foods: Calcium is key to hair growth. Dairy products, such as milk and cheese are Good sources of calcium.
  • Iron Rich Foods: Iron deficiency and thyroid related hair loss are related. You can get tested for iron levels in your body and consider supplements for iron rich foods like liver, eggs, lamb, green leafy vegetables and so on.

2. Apply Essential Oils: Essential oils like eucalyptus oil and other plant extracts are known to improve hair growth. But, it’s important to talk with your doctor before using essential oils and use caution while choosing a quality brand.

Furthermore, you should also always do a patch test before using any essential oil for hair growth.

3. Control Iodine Intake: People with autoimmune thyroid disorders should check their iodine consumption. The body uses iodine to make thyroid hormone, so too much of iodine consumption may lead to imbalances.

Therefore, It is very important to understand how much iodine you would require in a day.

4. Yoga Asanas: A healthy lifestyle, which includes balanced diet and regular exercise, can help you live well with thyroid disease. Furthermore, adding yoga to your daily routine may help improve your thyroid function and hair growth.

Yoga for healthy thyroid and hair growth

Dear Reader, please discuss the above mentioned home remedies with your doctor before you start.

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Levothyroxine

Levothyroxine is a medicine used to treat hypothyroidism. If you have hypothyroidism, it means your thyroid gland produce too little thyroid hormone. With low thyroid hormone levels, your body cannot function properly, which may result in poor growth, lack of energy, excessive tiredness, weight gain, hair loss, increased sensitivity to cold, joint and muscle pain, heavy or irregular menstrual periods, and depression.

When taken correctly, levothyroxine provides thyroid hormone to you and restores the balance of thyroid hormone in your body. In addition, levothyroxine also can be used to treat goiter, which is an enlarged thyroid gland. It also treats certain types of thyroid cancer.

Important Warning
1. Levothyroxine, should not be used to treat weight loss or to treat obesity.
2. Levothyroxine may cause serious or life-threatening problems when taken higher than recommended doses. Therefore, never take more than the prescribed dose.
3. Levothyroxine is only available on prescription.
4. Please talk to your doctor before you start taking levothyroxine.

Before taking levothyroxine

  • Tell your doctor if you are allergic to this medicine or any other medicine. Also tell your doctor if you have any other types of allergies, such as to foods, preservatives or animals.
  • Tell your doctor if your thyroid is overactive (producing too much thyroid hormone- Thyroxine).
  • Tell your doctor if you have diabetes. This drug may affect your blood sugar levels. Therefore, check your blood sugar regularly as directed and share the results with your doctor.
  • Tell your doctor if you have a heart problem including heart disease or heart failure, or if you have high blood pressure.
  • Tell your doctor if you have adrenal insufficiency (a condition in which your adrenal glands do not produce enough of hormone cortisol). Please note, Cortisol is needed for important body functions. Your doctor may tell you not to take levothyroxine.
  • Levothyroxine doses need to be carefully monitored during pregnancy. If you’re planning to become pregnant or think you may be pregnant, it’s important to talk to your doctor to get the right care for you and your baby.
  • Tell your doctor if you are taking any other medicines. This includes any medicines which are available to buy without a prescription, as well as herbal medicines.
  • Tell your doctor if you have recently received radiation therapy.

How and when to take levothyroxine

How and when to take levothyroxine
  • Levothyroxine dosage is based on your age, weight, medical condition and laboratory test results. Therefore, please take levothyroxine exactly as directed by your doctor.
  • Levothyroxine comes as a tablet and a capsule to take by mouth. Your doctor will ask you to take one dose each day at least 30 minutes to 1 hour before having your breakfast and drink like tea or coffee. Because, food and drinks can both stop your body taking in levothyroxine properly.
  • Take the tablets with a full glass of water as they may get stuck in your throat or cause choking or gagging.
  • If levothyroxine has been prescribed for a child, the doctor will tell you what dose to give. The dose for children depends upon their weight, age and what they are being treated for.
  • For infants, children or adults who cannot swallow whole tablets, crush the tablet and mix in 1 to 2 teaspoons (5 to 10 milliliters) of water, and give using a spoon or dropper right away. Do not store it for later use. Consult your doctor for more information.
  • If you forget to take a dose, take it as soon as you remember, if it is still within one or two hours of your usual time. If it is longer than this, skip the forgotten dose. Do not take two doses together to make up for a missed dose. To help you remember, take the dose at the same time each day.

Please note, use levothyroxine regularly in order to get the most benefit. It may take several weeks before you notice a change in your symptoms. Furthermore, continue to take this medication even if you feel well. Do not stop taking levothyroxine without consulting with your doctor. Thyroid replacement treatment is usually taken for life.

Levothyroxine side effects

Like all medicines, Levothyroxine may cause side effects, although not everyone experiences them. Once you are on the right dose of levothyroxine, side effects should go away. However, tell your doctor if any of the following mentioned symptoms are severe or do not go away.

Common side effects

  • Headache
  • Vomiting
  • Diarrhea
  • Fever
  • Increased appetite
  • Weight loss
  • Hair Loss (usually temporary)
  • Muscle weakness
  • Shaking (usually of the hands)
  • Changes in menstrual periods
  • Mood changes
  • Insomnia (Trouble sleeping)
  • Sensitivity to heat

Please note, if these side effects are mild, they may go away within a few days or a couple of weeks. However, talk to your doctor if these side effects bother you or do not go away.

Furthermore, some people may have serious side effects when taking levothyroxine. If you experience either of the following serious side effects, call your doctor immediately.

Serious side effects

  • Chest pain
  • Shortness of breath
  • Discomfort in your upper body
  • Extreme Tiredness
  • Swelling of hands, feet, ankles, or lower legs
  • Unexpected weight gain
  • Very fast heart rate
  • Irregular heart rhythm
  • Itching
  • Rash
  • Tightness in the chest or throat
  • Stomach pain
  • Nausea

Please note, this is not a complete list of possible side effects. Therefore, if you experience any other effects not listed above, speak with your doctor or health care provider immediately.

Levothyroxine and pregnancy

Levothyroxine is safe to take in pregnancy.

It is important to take levothyroxine throughout your pregnancy. Having too low or too high levels of thyroid hormone in pregnancy may cause pregnancy loss or miscarriage. 

I am suffering from hashimoto hypothyroidism and also due to my history of three miscarriages my doctor advised me to take Levothyroxine regularly and without any gap. Therefore, during my recent pregnancy I took Levothyroxine strictly as prescribe by my doctor. Now I have healthy twin baby Girls. (:

In addition, I would also like to share with you that, you will need to have regular blood tests during pregnancy to make sure you are on the right dose of levothyroxine.

Levothyroxine and breastfeeding

Thyroid hormones play an important role in the production of breastmilk. So if you have a thyroid disorder it’s important that your thyroid hormone levels are well controlled after pregnancy, as well as before and during pregnancy.

Breastfeeding is safe while taking levothyroxine to treat an underactive thyroid (hypothyroidism). Levothyroxine pass into breast milk in extremely low amounts that are too small to affect your baby. If you are breastfeeding, it is important that you continue to take levothyroxine, as this is replacing what your body would normally be making.

Please note, if you notice that your baby is not feeding properly, or if you have any other concerns about your baby, talk to your healthcare provider or doctor immediately.

Blood Test to determine right dosage of Levothyroxine

To determine the right dosage, your doctor will do regular blood tests to check the levels of thyroid hormone in your body before and after starting levothyroxine.

At the start of treatment, your doctor may advise blood tests quite often but once your thyroid hormone levels are stable and your symptoms are under control, the frequency of blood tests may reduce.

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