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[andius]

Well, normal postmenopausal range of estradiol E2 generally is reported as 0-30 pg/ml.  On no HRT  3 years after no periods, mine was 5 pg/ml....it was 12 pg/ml the year before.

I think the reason women have differences in their risks for disease and symptoms related to postmenopause is because one woman at postmenopause may naturally be at around 30 and another may actually be at around 2 based on body metabolism, size, composition, genetics, diet, exercise, etc.  If you are naturally 30 and your blood levels aren't tested and you take higher dose hrt trying to alleviate symptoms.....you would have higher risks of side effects/disease. but that might not matter depending on your activity?  If you are naturally 2 and take low dose hrt, your symptoms may not be relieved. This method of thought is overly simplified probably, as it does not take into account the varied (albeit small) differences in hormones that can happen naturally during the day, even if you are postmenopause. It also doesn not take into account the progesterone those of us with a uterus need to take in addition. It does indicate, however, why we have problems trying to figure out what IS the optimal dose for each of us and how you can't compare well with others on what YOU need.

Just my thoughts and I am still trying to figure out what I need, let alone what the risks of it are. LOL
I just want to get by without this darn genitourinary aggravation!!!

[andius]

Wow Hurdity!  Thanks SO much for posting that COMPREHENSIVE article.

I have just briefly skimmed it so far.

Several things stood out to me.

They show a graph (the last one) of 3 women given a  50 patch and the individual variations of the blood levels was striking....AND, the graphs were very similar (peak-trough like) to the one I pointed you to in the link I posted. Also, the second graph there shows short time variation in one women on one patch.  Maybe the top graph with the gradual decrease is actually an "average" based on the second graph? and was made to negate the short-time variation in one woman on one patch?

Also....much lower in article, it mentions vaginal estrogen 10 tablets affect vaginal cytology but have NO SIGNIFICANT effect on urethral cytology, unlike the vaginal estrogen 25 tablets!!!!!  If I am reading this right, that means I need to take vagifem 25 which is not available in US.  Whereas, the estring ring alleviates all urinary symptoms. I really am going to push for trying estring again (last time I tried it years ago I was not on hrt) to see if this will solve my issues.

Additionally, the daily graph for the gel has little peak-trough and looks like it has more potential for horizontal steady-state levels, but this comes with DAILY dosing.  To be honest, I seem to feel the fluctuations I am getting with my patches and this may be a good alternative for those of us who think fluctuation in hormone level is a problem when the levels go down before changing patch.

Regarding progesterone caps.....the levels are higher and sustained longer as we have discussed before, with less side effects.  I am limited on my estrogen dose because I can't seem to get my progesterone levels up, but I have not tried the vaginal administration route. I am going to discuss this with my doctor also. I think with my 100 sublingual dose, the progesterone probably rises quickly and falls, and when my blood is drawn is usually in daytime so the level is always lower (I take before bedtime). Who knows what effect we are getting from active metabolites that can't be measured though?
Luckily my lining now is the same as it was last march in thickness.

Regarding risks....my goal is to find some level that works well for a while, then I can try to decrease some to mitigate any risks involved.  I am still working and as many of you, I feel I need good levels of hrt to do my job.  After retirement, maybe it will be easier to lower hormone levels.

Again, thanks so much!

Andius

[Night_Owl]

Thanks for all the useful information, all very interesting.

Andius, from what I've read I don't think Vagifem 25s are available in any country now, unless old stock.  I use Vagifem 10 alternate days, they seem to help bladder issues slightly, only to a point though but my issues are more related to pelvic floor muscles being shot to bits.  So a re-try of Estring may be the way forward.

Well I've found my answer - as I can't keep the HALF 25 Estraderm patch on for a whole week anyway even if I wanted to, as it drops off!  I'll have to go with the twice weekly change at a slightly lower dose and see how it goes. 

One thing I thought was weird - on this ultra low dose estrogen I used to get no withdrawal bleed whatsoever on Cyclogest x 12 every six weeks - however since reverting back to Utrogestan x 12 every six weeks, I have been getting something - not a bleed as such, just nasty, black (eww, old blood?) lumpy gunk (sorry, if TMI) which alarmed me, that can't be healthy stuck inside the body.  Alongside the low dose patch, the Vagifem 10 alternate day use must have created this gunk build-up.  Or, maybe the Utrogestan is just stronger than Cyclo.  The meno clinic absolutely insist on 6 monthly scans, even on this low dose regime. 

Often it's difficult to understand what the body is doing.   And then it all changes again anyway ...


Night_Owl
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[Hurdity]

Hi Night_Owl

Just a quick message to say I had the same experience as you - eventually no bleed on Cyclogest but I always get a fairly substantial bleed on Utrogestan. OK mY cycle is longer now I'm on Utro but I don;t think that can account for the dramatic difference. Yes I do think Utro is stronger - I know Cyclogest is double the dose but it may have something to do with the mode of delivery ie the solid waxy capsules as opposed to the  Utro ones. Maybe more oozes out with Cyclo!

Anyway gunk or not - better out than in!

Hope it all continue to go well for you.

Hurdity xx

[andius]

Sounds like you solved your problem Night Owl....good for you!

[Night_Owl]

Thanks for replies.

Guess Estradot stick better and could be used for a week (however for me the adhesive/delivery didn't agree).

Hurdity, strange how you also found no bleed on Cyclogest, almost as if it dissolves any build-up.  I find v-route Utro definitely worsens bladder issues and although it is supposed to be the least androgenic, hair loss gets much worse.  Wish there was more of choice of prog, maybe one day ...


Night_Owl
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