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[Salad]

 I've just returned from my GP to get my most recent Oestrogen level result- bad news 

We've been anticipating a problem as my oestrogel dose has gradually been increasing in order to control my break through of symptoms. I use 4 pumps of oestrogel in morning to control all my symptoms in the day, then have been using 1-2 pumps before bed in order to get through the night.

My level has gone from 640 to 2300!

I'm now under instruction to reduce my dose but I am dreading having to experience my menopause symptoms AND try to keep working/living.

Has anyone had experience of Tachyphylaxis and know how long it'll take before I feel ok again?
Any advice really appreciated. 

Sat here feeling a bit sorry for myself with a cup of tea and some emergency chocolate my husband has just given me

[Cassie]

Sorry what is tachyphylaxis....

[Salad]

It's a progressive decrease in response to medication, so you increase the dose to counteract the lack of response.

My GP wonders if I'm absorbing the gel too quickly, hence the super high level then as the day goes on I'm using it up and the level slumps so my symptoms show up - instead of the steady absorption I'm supposed to be doing.

She's swapping me to a patch to see if that helps at all-  I guess anything is worth trying

[Hurdity]

Oh dear Salad poor you - how strange - that is a very high dose!  Patches deliver a very consistent dose and don't depend quite so much on the vagaries of application and absorption.

In terms of oestrogen and HRT tachyphyllaxis is explained here and generally is only a possible problem with implants:
http://www.studd.co.uk/implants.php

Too frequent implantation or too high doses of oestrogen leads to supra-physiological oestradiol levels and the recurrence of symptoms even at these high levels.(4) It is not easy to treat and it must be said that the secret is to avoid it happening by using the correct dose of hormones in the first place. The normal range of plasma oestradiol during the ovarian cycle is between 100-1500 pmol/l but plasma oestradiol levels greatly exceeding these values can be found in patients with tachyphylaxis.

The symptoms that these women suffer are real, not imaginary although they are not always typical menopausal symptoms.(5) In fact many of these women have a history of psychological disorders.(6) Because of this potential problem, the implants should be used with caution in women with a known history of chronic anxiety or stress disorders. The recurrence of apparently oestrogen deficiency symptoms at these levels are no doubt due to the change of oestradiol levels from "very high" to "high" and they become accustomed to a higher threshold. These high levels may be unnecessary and avoidable but sometimes women with convincing oestrogen responsive depression need even higher oestradiol levels but there is little or no evidence that they are harmful.

The above relates to implants but the same principles apply.

I hope you manage to sort it out and find the right dose Salad!

Hurdity x

[Joyce]

Patches worked better with me than gel.

Hope you can get it sorted Salad!

[Dancinggirl]

Hi Salad  - A colleague of mine at work who suffered with similar problems has found relief by adding the SRRI drug Citalopram alongside a lower dose of HRT. Many women seem to need both to control their symptoms.
I hope you get sorted.  DG x

[Salad]

Thank you for all your replies and the information Hurdity

It's a nightmare but guess I'll sort it eventually - things could be worse!

I'm using the gel for the next week as I'm super hectic at work and don't want to try the patch until I can cope with any increase in symptoms.

Ive been applying gel to my arms so I'm changing to my legs where I definitely have plenty of subcutaneous fat and maybe it will help me absorb more slowly.

Thanks again x

[lancashirelass]

Just noticed this having.bloods done from a gel arm will give faulty results im amazed your gp didnt know this.  Ask to be retedted and.only apply the day before.not.on.the day of.the.blood.test

[Salad]

Thank you for your advice Lancashirelass, that isn't something I'd thought of - (only just seen it as I've not been here for a while )

I made the swap to patches and once I'd worked out which one suited me best - I'm happy to say, HRT is working really well and I'm feeling good 

Keeping my fingers crossed that it continues!

[Joyce]

Patches worked much better for me.

[bev lloyd]

I have been on x4 pumps Estrogel for 8 months, suddenly, hot flashes after feeling great and no flushes since HRT patches/gel 4 yrs ago. Blood results went from 380, to 1,400 to 2,300!!!! all over 3 months, and now I am in despair-nothing is working, swapped to 100 Evorel even worse flushes, and x3 estrogel, OMG!!!! NO sleep, flushing all night. Now what? back to x4 gel, still sweating but not as horrific as x3. Tiny amounts of T gel as GP thought it may be converting to E, and Norothisterone for 10 days as Utrogestan did nothing to stop spotting. Also changed to x2 AM and x2 PM of O gel, it hasn't made much difference. Look 100 today, red sore eyes from the Norothisterone, and generally in complete despair. So much so that I took some DHEA to perk myself up. Any ideas?

[Floo36]

Hi, are you in peri menopause? If you are it seems that your own hormones are fluctuations which can cause spikes in Estrogen, does with me at the moment. 

[CLKD]

Hi - mayB ask for a patch which gives a more level dose 24/7?

[Salad]

Hi - mayB ask for a patch which gives a more level dose 24/7?

This is what I was going to suggest too 

I went from 4-6 pumps of gel to 175 mcg Estradot patches with much better results.

[bev lloyd]

Thanks everybody, I did try Everol 100 patch, they were always fine before, but now, argh!! flushes all night long, it's like nothing is working at all. Back to x4 gel. I am 56 today, lol, and way past peri, so I am thinking something happened with conversion of T or P to E..Maybe. I did stop T, as GP said it was probably that, but didn't feel any different, just felt all my muscles and energy disappear. It's really strange.. Boobs bigger, plenty of bleeding, so something is happening, but the flushes/poor sleep is ghastly!! I have a job/college course/2 kids under 13, and I'm single- I just cannot cope with this HRT hell. And dropping gel dose to x3 was really horrendous. I am taking DIM.. Can't say I notice any difference. every avenue now seems closed...