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[Spangles]

Hello ladies
How do you know if you need more oestrogen?
Although I've got a lot going on at the moment, past few months have been a bit of a struggle mentally. When I last went to the doctor she did suggest upping my patch from 50 to 75.
I am reluctant to do this, have any of you increased and if so why? And what were the results for you?
Thank you
Shellb
xXx

[Dancinggirl]

Shellb - this is a difficult one.  If there is a lot going on and you are not feeling mentally good - low mood and anxiety etc. - then extra oestrogen may not be what you need.  We all go through tough times and this will pass or we learn to deal with things; if your flushes and night sweats are under control and you are getting some reasonable sleep then I would stick with your current patch and see what else you can do to control the mood side of things. I personally find Mindful Meditation really good and I have learned to take life a bit more easily these days.  Reading so many posts on MM about women suffering really badly with anxiety and they keep upping the amount of oestrogen they take with no really effect, I now believe that sometimes an SRRI like Citalopram alongside HRT seems to be an option that can work.  I have a work colleague who uses both HRt and Citalopram and is doing really well. 
I would pursue some other options - maybe ask for some CBT?  I had CBT and counselling for a year at one stage when life was tough and it really got me through and I emerged much stronger.  DG x

[Spangles]

Hi DG
I have had CBT in the past but it had little effect and I also take citalopram 40mg. I'm going through a rough time at the moment and just looking for a little relief.
xXx

[Dandelion]

Hello ladies
How do you know if you need more oestrogen?
Although I've got a lot going on at the moment, past few months have been a bit of a struggle mentally. When I last went to the doctor she did suggest upping my patch from 50 to 75.
I am reluctant to do this, have any of you increased and if so why? And what were the results for you?
Thank you
Shellb
xXx

I would imagine, but not sure, that if you were on hrt and your symptoms started creeping back in, ie, needing a fan, going out dressed inappropriately (like me, last november, in a vest) then though would indicate your hrt dose is no longer sufficient. I am not sure, but I don't hink you have too much oestrogen as the body just gets rid of the excesss
I went up the doses in patches, the reason was, I started on femoston, 1/10 and then 2/10, because I was still getting bad flushes.
The doctor I saw was reluctant to give me more, because she thought I would treat them like the valium that I was on. This puzzled me as oestrogen in not an addictive drug. but as she was quite curt when I spoke about hrt, it put me off going back to her, when the femoston 2/20 wasn't working.
I eventually went back armed with a letter from Dr Currie, asking for evorel plus utrogestan, as I was unwilling to try norethisterone, because other people had experienced bad mental and emotional side effects.
I didn't bother with the 25mcg patches, and bought myself 50mcg patches which worked a bit, not not enough to stop soggy bra syndrome and IBS. It was the IBS that stopped me from absorbing the femoston tablets.
I had another letter from Dr Currie saying it was ok to give patients with migraine patches, and I went back and saw a different GP who was willing to try me on 75mcg patches.
These worked a little better than the 50mcg but still not enough and the flushes were still troublesome, so, after a three months trial I went up to 100mcg patches and here I am still, dry bra, flush free, and the anxiety and depression have improved, but i have circumstantial things in my life that cause depression, nothing to do with my body, more situational.

I would imagine, that if my old menopause symptoms started to come through, I would have to request maybe wearing a 25mcg patch along with my 100mcg, or 50mcg if 25mcg was not sufficient, but I can't imagine the 100mcg patch being insufficient, as I am seven years into my perimenopause, and I still had periods for years after I started flushing.
I hate the way the doctors wont allow more oestrogen due to the risks, surely it is up to us as the patients as to whether we want to run the risk, which is small, by the way. I would rather run the risk of cancer, than live an un-liveable life, with a risk of suicide, as I was suicidal.
The doctor asked me how long I wanted hrt, and I said for life, and she refused, I said that without hrt my life was not worth living, and she said that although she didn't want to make my life bad, I would have to stop hrt at 55.
I know a few women who are still flushing at 55.
The doctors don't believe this, they think that by 55, all women are through the menopause.
Bottom line TL/DR syptoms emerging while still on patch indicates insufficient oestrogen. My meno based anxiety has all but gone, now that I am on the higher patch.

[Dancinggirl]

Shellb - you describe that you are going through "a rough time at the moment" which indicates to me that this is not a permanent thing but perhaps a time with extra pressures and anxieties that may well pass? 
I can't remember if you have had a hysterectomy or not? If so your could increase your oestrogen quite easily. However if you still have your uterus then the progesterone would have to increase with extra oestrogen and this could then have a negative effect on your mood. 
To increase the oestrogen in the hope that you might cope better with current stresses etc. may not achieve anything - you could try but I am personally sceptical that this will improve the way you cope at present. If your anxiety and low mood is nothing to do with issues going on in your life right now but you just can't cope with day to day life generally, then I think a trip back to the GP to discuss this, perhaps up the oestrogen dose or the SRRI and see if this improves. CBT is not something that works wonders right off but is something that needs to be put into practise all the time and should work to control mood in the longer term - this is why I mentioned 'Mindful Meditation', as this is a type of CBT is something one should practise each day and particularly when feeling anxious as it helps to deal with situations 'at that time' and control the negative moods and anxiety - having said this it does take time to build this into your life - it is not a quick fix.

As Dandelion points out, menopause is so different for all of us and she has had a real struggle to get to a good place - particularly regarding mood and controlling flushes.

You could try the increase in Oestrogen and see if it helps.  DG x

[Spangles]

Ahh thanks ladies, you are so kind.
I already use citalopram 40mg, evorel 50 and utrogetsan 200. I didn't have a lot of success with CBT. I'm reluctant to change anything, just looking for options really.
If I could sleep a little longer I'm sure I would feel better. Please can you tell me what 'soggy bra' is as this isn't something I'm aware of.

Thanks
Shellb
xXx

[Hurdity]

Hi Shellb - in answer to your original question it depends where you are in menopause and whether oestrogen is controlling the main symptoms. The main issue re HRT and dose is that we are all counselled to take the lowest possible dose that controls the troublesome symptoms - which are the classic indicators of hot flushes and sweats. However controlling other symptoms and leading to a sense of well-being is another matter entirely and somewhat more subtle.

The dose of HRT required to control symptoms is often the dose that gives background average estradiol levels of the follicular phase of the menstrual cycle (first half) I understand, whereas the actual cycle gives a rise and fall - including a dramatic rise before ovulation. This is usually when women feel at their best. However it is impractical to maintain oestrogen levels this high all the time (and probably not desirable physiologically) - not least becaue of the high doses of progestogen needed to keep the womb lining thin.

Therefore the dose we take is a compromise. It may well be that the dose is too low to keep you feeling at your optimum and if you are still peri-menopausal then your own hormones will be also fluctuating so making things more difficult to ascertain what's what!

How old are you anyway? I don't see a problem with increasing to 75 mcg, especially if you doctor has advised it - except it will make it more difficult further down the line to reduce if you are sensitive to small changes in dose. However as you say you are on ADs already - this muddies the picture so who can say what you need really if it's a question of mood. In your case you will not be able distinguish between physchological symptoms that you are having anyway and those due to hormonal imbalance. Personally I would still give it a try ( 75 mcg) and see how you feel. I presume you are having withdrawal bleeds regularly?

As for "soggy bra" - that seems obvious to me! Sweats so wet that you are wet through - and an indicator of how bad your menopausal symptoms are!!! Is that so Dandelion?!

Hurdity x

[Spangles]

Thank you Hurdity
I had a good day yesterday and I am hoping for another today. I'm 47 and I would love a life with no AD's and no HRT but that's a long way off.
I just wish there was a way for us to see how far along the meno journey we actually are.
Shellb
xXx

[Dancinggirl]

Shellb - At 47 you really do need to keep on the HRT as it will be beneficial for your heart and bones in the long run. For many of us (I'm 59) we need to keep working until we are at least 66 so HRT can enable us to keep working. Having gone through some of your other threads it does sound as though you going through a tough time privately and with work and I have had many times like this. You are at an age when your own hormones may be dropping a bit more so as Hurdity has rightly suggested it could be worth trying a bit more oestrogen to see if it helps - you can always drop back to the 50mcg if it doesn't help. We sometimes talk about finding a 'sweet spot' - in other words trying to find just the right amount of hormones to make us feel good and this can be difficult when in the peri stage.
It is very easy in life to focus and feel anxious about things over which we have no control - I have a mother who is very good at manipulating her children into feeling really guilty we are not giving her lots of attention. It's taken many years for me to manage this manipulation and actually focus on my needs more. I now do less for her and she is far more appreciative!!!! We women are programmed to nurture so often feel a strong sense of responsibility and a need to look after others; try to remember that if you are feeling good then this is beneficial for all those around you - so basically learn to be a bit more selfish and do what is right for you first.  DG x