01How she was feeling when she came to us

If you have been told your results are normal but you still feel far from yourself, her story may sound familiar. In her early 50s, she had been living with a cluster of symptoms for about two years. Fatigue topped her list, followed by bloating, anxiety, brain fog, poor sleep, weight gain around her middle, mild hot flushes and low libido. Most nights she slept about four hours, and she told us the past year had felt like a deep loss of vitality.

It had all begun within months of surgery to remove one ovary, and her periods had stopped. She had already tried programmes elsewhere, melatonin and magnesium for sleep, and supplements for energy and recovery, without any lasting change.

She came to us wanting four things: sleep that left her rested, the energy and strength for an active life, her usual shape and libido back, and a clear answer on whether the surgery had brought on her menopause.

02What her tests showed

Because she was in her 50s and her periods had stopped, Dr Nirusha could recognise menopause from her history. Her first blood tests were about making treatment safe and planning it well, so they covered her thyroid, cholesterol, iron, blood sugar, inflammation and vitamin D. They confirmed a postmenopausal pattern, with oestrogen too low to measure, and a tumour marker came back reassuring.

Her blood sugar and insulin were healthy. Her thyroid result (TSH 3.19 mIU/L) and her iron stores were inside the laboratory range, though not where we would like them for someone feeling the way she did, so we kept a close eye on both. A raised count of eosinophils, a type of white blood cell, led us to arrange a stool test.

03Was this surgical menopause?

It was the question she most wanted answered. Surgical menopause means both ovaries have been removed, and she had surgery to remove one. Even so, her periods stopped within months and her blood tests confirmed she had gone through menopause, so her menopause care followed the same principles. The most accurate way to describe it is menopause that followed ovarian surgery.

Can thyroid problems feel like menopause? Yes. Tiredness, weight gain, low mood, poor sleep and brain fog can come from either, so we checked her thyroid from the start. Her first result was within range. Three months later, repeat bloods found thyroid antibodies and a mildly raised TSH, showing Hashimoto’s thyroiditis at an early stage. Her cholesterol had risen at the same time. That often happens when the thyroid slows down.

04The plan we made together

We started with hormone replacement therapy: oestrogen through the skin, progesterone at night, local vaginal oestrogen and a low dose of DHEA. Fluid retention was a problem at first, so Dr Nirusha adjusted how her oestrogen was given, moving between a patch, a gel and a pharmacy-prepared cream and checking her blood levels along the way. Later, a very low dose of testosterone was added for low sexual desire that oestrogen alone had not helped, and her progesterone was increased to support her sleep and protect the lining of her womb.

Once Hashimoto’s was found, she started a low dose of thyroid medication (levothyroxine), with a repeat test three months later. We stopped a supplement that contained iodine, because extra iodine can make autoimmune thyroid disease worse, and topped up her vitamin D, iron and trace minerals. Cholesterol medication could wait while her thyroid settled, so we added omega-3 and advice on saturated fat. A nutrition consultation helped her try a diet without gluten, dairy and soy, as a personal trial to see how she felt.

05How things changed over seven months

Change came gradually. At month 2 she was still waking between 2 and 3 am, and a body composition scan showed she had kept her muscle but was holding fluid, with her weight about 6 kg above her usual level. By month 4 her energy, the thing she most wanted back, had improved. Sleep was taking longer to settle.

By month 7 she felt better overall. She had built steady habits around organised meals, cutting out gluten, dairy and sugar, evening walks and lymphatic drainage, and her weight was 3 kg lower than at month 2, inside the healthy range. Her blood results moved in the right direction too. Over about three months of thyroid support, food changes, omega-3 and gradual weight loss, her TSH came back into range and her LDL cholesterol and apolipoprotein B both fell by about a fifth.

06What comes next for her

Her care continues. At month 7 Dr Nirusha increased her oestrogen dose for better symptom control, fine-tuned her testosterone and kept progesterone at the higher dose to protect her womb lining after a routine pelvic scan, with a repeat scan planned. Vitamin D moved to a maintenance dose and iron to a lozenge. A bone density scan is recommended, stool and allergy tests will look into her raised eosinophils, and her bloods will be checked about every three months until everything is stable.