I started the menapause 2 years ago. Like you I on levothyroxine (I have no thyroid gland) and I have kidney issues. I was offered HRT but declined it due to the risks that brings. I was offered Gabbapentin, it's an alternative to HRT but Drs don't like you being on it too long as it's addictive. I declined that too on the basis that it's addictive.
I have zero sex drive, but can manage bookings. But I do massage HR a lot as well as escort.
What I have found helps is wearing clothes in light layers, so when I feel the flush start, I literally strip layers off, especially upper body. I basically have nothing on my shoulders or top back area. Sipping water when the hot flush starts helps too. Flushes come hard and fast for me a few weeks at a time, then go away then come back.
Exercising helped with my mindset. As I get moody, depressed, angry. It really does help. It also keeps the weight down. I found I gained a stone with menapause, but I am have got that off now and my figure is very very good now, all down to weights and exercise.
The broken sleep, I have been using meditation apps with headphones to help me get back off to sleep. I still wake up at stupid o'clock and fall asleep early in the evening. I not found anything helpful for this, but if anyone else has please say, as I really struggle with this. And if I honest I have been smoking a joint every night to knock me to sleep but I don't want to keep doing that.
When I am on a "angry" day, I can't work. When I am on a "fatigue" day I don't even get dressed. These days there is no point even trying as I would put myself in a very bad mood and even the slightest misdemeanours from clients I want to physically hurt them lol. So listen to your body.
I also take Well Woman Menapause Vitiams daily, which I buy from the local supermarket, probably just an angle at selling us higher priced Vitiams but as my appetite has gone it helps put back in my body what my body needs. I haven't noticed any difference to be honest but I still take them.
I found Drs attitudes crap, it's either take HRT or get on with it.
Sex work whilst going through the change can be difficult, as some days I feel as sexy as a bag of spuds.