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[Joesmum]

Hello everyone
I'm new here
I had a BSO and hysterectomy at 46 which is 5 years ago.

Since then I have felt good on oestrogen implants. Recently I let them run low and my symptoms were horrendous.

Dizziness, vertigo, anxiety, panic, adrenaline surges, depersonalisation, crying constantly, nausea, insomnia, irregular heart beats, hot at night, flushes during the day. ....... The list goes on.

I also take thyroxine but it's definitely not my thyroid because my levels are good.
I spoke to my GP and he has given me some EVOREL patches 50mcgs. I'm only on day 2.

I just wondered if anyone else has been this symptomatic with these blood levels? My ENDO used to keep my levels higher but since I'm 51 I thought I'd see if I could get away with a lower level. The symptoms would suggest otherwise.

Thanks for reading.

[lancashirelass]

Why cant you get another implant that would be the best solution.  They are the best method for surgical ladies

[CLKD]

 

[Mary G]

Hello Joesmum and welcome to MM!

I'm not surprised you feel that way you do with those levels of oestrogen, I think they are far too low.  To give you some indication, I have converted some of my own blood test results (I always work with pg/ml but have converted it).  Your level comes out at about 60 pg/ml.

When I was immediately post menopause, my oestrogen blood level was 20 pg/ml which is about 73.00 pmol/l but I didn't have anything like the severe symptoms you are having.  That said, I did have constant vaginal irritation, bad thermostatic control - breaking into a sweat too easily and not adjusting quickly enough to changing temperatures, silent migraines, night time panic attacks in hot weather. 

When I took Angeliq and topped it up with a oestrogen patch, my level was 75 pg/ml which is about 275 pmol/l but that was no good for me either and did very little for my dodgy thermostat or other problems and I certainly didn't feel good on it.

I have since started using oestrogen gel and have found it far better that every other from of HRT in just about every way.  It works better and you can adjust the dose to suit your needs and I can't recommend it enough.  My blood oestrogen levels are now very high, too high in fact, but my last reading was 238 pg/ml which is over 873 pmol/l and I feel completely normal on this level and obviously don't have any symptoms. 

My level is too high but that is partly due to the fact that I take 25mg DHEA tablets every day and the gynaecologist said I have started making my own oestrogen again because of this - DHEA works better when used with HRT.  That said, she does not value oestrogen blood tests at all and does not think it is a good way of deciding on dosage, she prefers to work on symptoms because everyone is so different and what you produce in your blood levels is not the be all and end all - her words not mine.

See how you get on with the patches but if they turn out of be disappointing, definitely try the gel.

hope that helps.

[Mary G]

Joesmum, that is very interesting.  So it's not just me who feels good on 800 pmol/l (ish) then.  Mine is slightly higher now as you can see but it would explain a great deal. 

Your are only 51 and too young to be reducing your levels in my opinion.  I am 54 and have no intention of doing so although I might try to get it down a bit. 

You are very fortunate that you don't have to ruin your HRT with progesterone and I still think you would do very well on the oestrogen gel.  It works extremely well and it is flexible meaning you can easily adjust the dose to suit your needs.  I used to have patches but I couldn't get enough oestrogen out of them, they didn't stick very well and they used to irritate my skin and leave itchy bumps and a horrid black mark.

I'm afraid I don't know anything about inplants but that could be an option for you. 

Your are right about it being a lonely experience.  I've coped on my own with it for years and didn't know anyone else my own age with the menopause.  For years, the only non-medical person I discussed it with was my partner.  I had to do all my own research and sort out my own medication as well which was a challenge.  I eventually consulted Professor Studd, switched to the gel and finally got back to normal.  I hope you can too.

[Briony]

It's really interesting to read this, as it seems to be the opposite of what I have experienced. When my estrogen was low (41 pmol) the key symptom was pain/tingling  shoulder, leg, fingers and mid back. I am now on 100 mcg patches and have got the worst dizziness, vertigo and fatigue that I've had since I hit peri menopause . I think perhaps my body prefers the middle ground, though I know I am probably the exception ?

[lancashirelass]

Implants give the best bone protection for surgical ladies arudies that Nick panays team have been involved with have confirmed that.  He spoke at daisy network conference about it

[Hurdity]

Hi Joesmum

  from me too.

I agree that if you have had surgical menopause and you have found a treatment that works ie the implants then do continue with this as you are still young.

Notwithstanding other members' experiences about how they feel on different oestrogen levels - from what I've read, research shows that there are no absolute oestrogen levels which are an indicator of when a women will or will not experience symptoms such as flushes and sweats and as pointed out it is often the drop in oestrogen that triggers these symptoms - but seemingly not during the normal menstrual cycle otherwise we would all have them all our lives!

As you have had a hysterectomy and don't need to worry about progestogen then why not have the level you feel good at. I can see your point about maybe trying to reduce - but you are still young at 51 - I haven't even started peri-menopause then.

For the rest of us - while many of us might feel even better on higher doses of oestrogen, if we have our uterus, we have to take progesterone and this is usually the limiting factor for our oestrogen dose! Also as a complete contrast my levels when last measured were something like 212 pmol/l - so as yours are (and I am on a 50 mcg patch) - but I suffer no symptoms of flushes and sweats nor joint aches or low mood so this is fine as a post-menopausal oestrogen level for me! I am not raring to go with enthusiasm all the time and if my levels were 300 pmol/l + then maybe I would be - but I don't want to take progesterone more often nor have a heavier bleed.

I did read that HRT doses were designed to give an average oestrogen level across the whole menstrual cycle of somewhere in the 300's (in pmol/l). I'm not sure what would be the consequences ( in terms of health, cancer risk etc) to have levels at the ovulatory peak for the rest of your life - but there are no data on this as far as I know!

The ref ranges for estradiol are here:
   
    70-510 females: early fol. phase (day 5)

    390-1480 females: preovulatory peak

    70-600 females: luteal phase

    < 130 post-menopausal

For most of us it's a compromise between eliminating symptoms and taking progesterone/bleeding - but for you - I would make the most of it and go for the implant. The other alternative is to slowly increase your patch - so go to 100 mcg and see how you feel and take it from there.  You might find that you feel good on lower levels than 800? 50 mcg is very low following on from an implant!!

Hurdity x