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[donnacrichton]

Hi I was advised with the symptoms I had to reduce elleste solo from 4mg to 3mg. I was put on such a high dose as only 42 and nothing was touching symptoms. I have had a few HRT's that have worked for maybe a month at a time but symptoms return. I have been on Elleste solo for few months after trying patches. The patches worked for 7 weeks then back to symptoms. I have reduced the dose for 1 weeek and thought it was going ok. After reducing dose felt an instant relief but last two days have been awful. Don't know if this is my body getting used to 3mg or if I need to reduce it more. I am shaky with anxiety and burning. How do I know if I need to reduce more or let 3mg settles.

[Dancinggirl]

donnacrichton - remind us again what you are on apart from HRT. Are you on any ADs?
As you are on an oestrogen only HRT I assume you have had a hysterectomy?
Chopping and changing different HRTs and doses may not be allowing your body to settle.  The anxiety may be making things worse and you might benefit from adding other medication for a while like an AD. A colleague of mine at work has recently been put on citalopram alongside HRT and feels fabulous
I think it could be worth trying Oestrogel as you can apply this twice a day to give a consistent dose and increase or decrease until you feel good.
It is thought that the transdermal route can be more effective as it doesn't have to go through the liver.  I used Oestrogel for most of the 20 years I was on HRT and found it the best option.   DG x

[donnacrichton]

Hi thank you for the reply I have the Marina Coil fitted and had a d&c and biopsy for the bleeding. That has been 3 years been bleeding. I was on Estradot 2mg and worked great for 2 months then all symptoms came back including flushes. I am on Amitriptylene as they though some of the tingling in the head could be nerve pain. My symptoms only appeared at age 38 when I came off Seroxat and I didn't know was used for menopause symptoms. It took a year to work out it was menopause. I have dropped to 3mg and don't know whether to drop a further dose to 2mg. Waiting on the consultant to phone back. Symptoms at the moment are better than last week until yesterday. I have cried for 2 days for no reason and don't know if that means I need to drop further or let my body settle. The consultant did say if no improvement would try a weekly patch. Boobs still a bit tender which he says means too much estrogen and flushes which means not enough. I am lightheaded and no appetite anyone who has an understanding on estrogen levels please replyX

[Dancinggirl]

HAve you been constantly bleeding even with the Mirena fitted? That does sound strange!!!
I'd ask for Oestrogel so you can adjust the dosage yourself to see what works.
You sound so stressed and unhappy I do wonder if some Citalopram would help - perhaps ask about this? 
I would try dropping the oestrogen level a bit more -  2mg is still pretty high.
HAve they checked your thyroid function?
DG x

[donnacrichton]

I wont try another AD they tried me on everyone before diagnosing perimenopause. I have been told it's probably the estrogen making me bleed but they tried me on HRT with progesterone and my body didn't like progesterone phase. Does high estrogen levels also cause tears and anxiety? I am so confused I had my levels checked when on HRT and levels were still low that's when they upped the dose to 4mg.

[Dancinggirl]

I have to say I am baffled as to why you are bleeding constantly - this can't be good. It may be making you anaemic which would cause you to feel tired and under the weather and would certainly increase anxiety.
If the blood test showed low oestrogen even when on HRT then I'd say you are not absorbing oestrogen properly!!!!
I was suggesting an AD alongside HRT as I think some women need both - particularly if suffering with anxiety.
I once tried an HRT patch when I was still peri menopausal which was 2mg oestrogen and felt very jittery - didn't like it at all and I think 2mg was too high for me at the time.
I really think you need a total reassessment by a gynae as you've clearly jumped from one treatment to another without really looking at what you need.
Keep a diary for a few weeks and then make an appointment to discuss how you are feeling and maybe then the doctors can properly assess what you need.
DG x

[Hurdity]

Hi donnacrichton

My view is that if you are needing a high dose of oestrogen I would not change from a patch to a tablet. 4 mg is a high dose which has to go through the liver - before you get the levels of estradiol you need in your bloodstream and I understand a lot of the metabolites ( from the tablets) are excreted.

You will definitely notice the difference having reduced from 4 mg to 3 mg and your body will be reacting to the metabolic effects and then to the reduction in oestrogen. High oestrogen does not cause tears! Sometimes a sudden increase especially if taken in tablet form can cause strange side effects - these do not occur during the natural menstrual cycle. Adding oestrogen - even bio-identical oestrogen exogenously (ie from outside the body) takes a while to adjust to.

In your position I agree with Dancinggirl and ask for a re-assessment with a gynae.

Personally I would use either patches or gel as you do not have to deal with metabolising the pills, and the oestradiol goes straight into the bloodstream. I can't see what level of Estradot you were on? It should have been possible to increase the dose slightly to see if symptoms would abate? Sometimes it is a fine balance and we all have to find our "sweet" spot - just the right amount of oestrogen to minimise symptoms as well as to feel good.

There is a condition called tachyphyllaxis when supra-physiological levels of oestrogen ( ie higher than the levels normally experienced by the body) cease to be effective and can cause a resumption of symptpoms.

If you are still peri-menopausal and still having a strong cycle (and big fluctuations in hormones) it is likely that sometimes the oestrogen dose may well be too high - which is why it is not usual to give such a high dose in peri-menopause.

I agree I would not consider ADs for symptoms that are hormonal in nature and this is not recommended as first line of treatment - you need to get the hormone balance right first!

Hurdity x
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[donnacrichton]

Thank you so much fir the reply just realised on other thread. I was on 2mg estradot and having good & bad days but was nearly getting there. Then they decided to try tablet for as estrogen level was still low on patch. What would be the best course of action just now. It felt like the level of tablet was getting stronger that was 6 weeks. Did feel relief when it was reduced but below 3 I am a wreck. I still have estradot and understand it doesn't need to go through the liver had instant results when tried it first time around. X

[Dancinggirl]

The Transdermal route - patch or gel - is usually the best way forward - as Hurdity has explained it has better absorption. If you still have some Estradot patches left then you could possibly try going back to them.
I am still rather confused about what exactly is going on though as you say you are still bleeding all the time which shouldn't be happening!!??
With all the chopping and changing I think your body just doesn't know where it is.
Definitely ask to see a gynae or go to a menopause clinic to get a proper assessment of your needs.  DG x