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[Clovie]

Firstly - sorry for all the questions of late  (Just trying to be as well armed with info as possible before I see a GP) 

Just a quickie - been reading lots of stuff on here about oestrogen levels and now got myself all mixed up. Argghhh 
Been looking into it as going to ask my GP for oestogel instead (bio-identical, right?)

Any-hoo, I'm now wondering if my anxiety/depression and joint paint could be caused by not enough oestrogen?
I'm on 2mg of Ellesste Solo.

Could it be I need MORE oestrogen? 

Can you take more than 2mg of oral synthetic oestrogen?

If you use oestrogel instead, what is the equivalent dose to 2mg of Ellesste?
Also, what is max number of pumps per day you can safely use?

Thank you.

[CLKD]

You need Huridty here  …….. it's OK to ask away, that's what we are here for 

You could use the search button for Elleste Solo - also it is known that as oestrogen levels drop off, muscles become lax = more aches and pains.

[Clovie]

You need Huridty here  …….. it's OK to ask away, that's what we are here for 

You could use the search button for Elleste Solo - also it is known that as oestrogen levels drop off, muscles become lax = more aches and pains.

thank you CLKD   didn't want to 'overstay my welcome' so to speak 

That's interesting about the oestrogen too.

[Meeka]

It states 2-4 pumps on the oestrogel tube.  I know prof stud has prescribed up to 5 in some instances.

Hurdity will know more.

[CLKD]

No one 'overstays' their welcome  - that's the point of this Forum to share and support !

[Clovie]

It states 2-4 pumps on the oestrogel tube.  I know prof stud has prescribed up to 5 in some instances.

Hurdity will know more.

great to know, thanks 

[Mary G]

Clovie, Professor Studd often prescribes 4 pumps of gel but that is considered to be a high dose.  Most women start on 2 pumps and then adjust it up or down if they need to. 

The problem is, everyone absorbs all types of products differently and whatever the equivalent dose may be on paper, it can be a different matter in reality.

Roughly speaking, two pumps of gel is equivalent to a 50mcg patch but I can tell you that having used both these methods, my personal absorption rate is very different and I absorb the gel much better than the patches and it registers much higher on my blood test results.  Same goes for the tablets, when I was on 1mg of oral HRT, I found it did not work very well and blood test results bore that out - they also gave me indigestion.  2mg is obviously higher and I don't know what the gel equivalent is on paper but again, it will depend on the individual and how well you process oral HRT through your digestive system. 

These are only my personal experiences but I hope that helps.  Having been around the block on this one, I would always recommend the oestrogen gel because it is bio identical, I think it works better and also the transdermal route is better than the oral route.
 

[Briony]

I'm pretty sure that Ellesste Solo is not synthetic estrogen as it's estradiol . Synthetic estrogen is the sort found in most birth control pills (ethinylestradiol, usually at a dose of 2-3.5mg). The is much more potent than the more natural type of estrogen found in hrt (think I read somewhere that the estrogen in BCP is 3-5 times stronger?). My doctor told me that 50mcg pacthes/2 pumps is equivalent to 1mg estradiol, but I know there's some disagreement about this. It's hard to compare as the delivery routes are so different.

http://www.earlymenopause.com/hrt_equiv.htm


Gels and patches are thought to be the safer route as they by-pass the liver. They also tend to have fewer side effects. To some degree, whether you take more or not will depend on your exact circumstances. For example, at 43, I take the equivalent of 4 pumps a day as I still have periods and want to suppress ovulation (ie avoid fluctuations/severe PMS). If I take less, ironically my estrogen sometimes gets even higher, as a lower daily dose wont suppress ovulation. 

Do you have a supportive doctor? Perhaps you could email Dr Currie?

B

[Hurdity]

As others have said you can't really give an equivalence other than low, medium and high because there is such a huge difference in how women absorb these products and the equivalence is based on an average of a number of women. A paper I have on the pharmacology of all of this mentions the variation:

"In contrast to the general belief that is
based on the graphic presentation of mean values,
a wide range of estrogen serum levels are
measured in women treated with the same
patch. Using patch or gel, there are large
interindividual variations in the estradiol levels,
which may differ by up to a factor of 10, and, in as
much as 30% of the patients treated with a 50 mg
patch, the estradiol concentrations are low. There
are also considerable short-term intraindividual
changes in the estradiol levels "

The main thing to note is the variation by up to a factor of 10!!!! That is huge!!

Some women who have had total hysterectomy with ovary removal are prescribed higher doses than the maximum (ie higher than 2 mg oral oestrogen or the higher premarin, 4  gel, 100 mcg patch) - but it's not usual otherwise and should not be necessary. Moonbeam I think is one of them.

You would not want to achieve oestrogen levels that are at the ovulatory peak - ie very high - throughout your whole cycle, all the time. I think I said recently elsewhere that I read that HRT doses are designed to approximately give an contstant oestrogen level averaged over the whole cycle - somewhere in the 300's pmol/l - although some women have stated they regularly have higher than this and feel great but the downside is the amount of progesterone needed if you are rarely ovulating. I gave the ref range on another thread recently but here it is again:

         70-510 females: early fol. phase (day 5)

    390-1480 females: preovulatory peak

    70-600 females: luteal phase

    < 130 post-menopausal

However the aim is also to reach the level at which symptoms (of oestrogen deficiency) are eliminated - but as you say this is tricky in early peri-menopause because adding a very high amount to an oestrogen peak will probably cause symptoms too (I've no idea about these!).

Yes Elleste Solo is bio-identical as Briony says - all the ones containing estradiol are - including tablets, patches and gel. They are all synthetic products though, in that the estradiol has been manufactured in the lab from the raw material which comes from plants ( soy/yam I believe?).

I had forgotten you were on oral oestrogen and yes I would completely agree that a transdermal oestrogen preparation could make you feel completely different - maybe better! For a start they don't have to be digested and then metabolised through the liver -  a lot of the estradiol is metabolised to estrone so maybe this affects how one feels?

And Clovie - don't ever apologise for asking questions!!!!!!!!!! Only very rarely do members "over-stay their welcome" and then it's obvious

Hurdity x

[PoshPenny]

Hi I just had something similar myself where I was on estrogel/utrogestan and then the flushes came back and other stuff.  I increased oestrogel to 4 pumps myself and it made no difference.  I went to GP and she appears to have put me back on track by changing me to Vagifem and estrodot 50mcg patches.  I'm sleeping so much better and so much less fiddling about with a patch that needs changing 2x a week rather than applying the gloop every day.  So yes, I think you could well find a difference with a different HRT to the one you're using

[Clovie]

Thanks for replies, great information, as always 
I'm going to ask to swap to the gel for sure. Wasn't initially wanting to get into the whole rubbing gel in scenario, but needs must! Anything to try feeling better, very small price to pay.

And sorry for getting mixed up about Ellesste being estradiol and it not being bioidentical. Thanks for explaining 
(my head has been mashed with all this!  )

[Hurdity]

Good luck Clovie! By the way you don't need to rub it in - you just apply it to the skin and leave it to absorb - although I know some women like to rub it in. If it's anything like testosterone gel it is a clear gel and quite slippery. I don't rub in my T gel because it isn't like cream and I would end up rubbing half of it into my fingers!

PoshPenny

 

Hurdity x