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[Lucy34]

Hi everyone I'm 34 and had a complete hysterectomy 3 years ago. I was on implants and had my last one 2 years ago in October. I had 4 in total since my hyst.

My implant doesn't seem to have however ran out! My last oestradiol level was 389, without topping up! I was told the implant may be working still or it's possible I have a piece of ovary left! I was advised to top up with patches so tried a full 100mcg patch and a 50mcg patch, but didn't feel any better. My last oestradiol result with half a patch was 864! So I clearly have some oestrogen coming from somewhere! I'm hoping it is the implant and it runs out soon.

My problem is I believe I'm very sensitive to fluctuations! I can't control what's happening at the moment and I feel awful. I suffer from migraines, anxiety, fatigue, sore breasts and crying spells.

I recently saw a Dr who believes my levels haven't been high enough for long enough. She advised me to take 4 pumps of Oestrogel. I tried this (although only for a few days) and felt really bad! I stopped this and felt better the first day, but now feel really bad with anxiety! I don't know what to do next! Should I just stay off the HRT until the implant runs out or do you think I should try a lower dose of gel? It's so hard to know, I just don't feel well at all and need to get rid of the anxiety if possible! Any advice is greatly appreciated!
X

[Hurdity]

Hi Lucy34

 

Sorry to hear you are having a rough time. I presume you had your ovaries removed (BSO) as well as the total hysterectomy (TAH) - which is why you have been given implants?

It's a tricky question this and one that challenges many of us. Normally our oestrogen levels cycle up and down and from what I remember the average throughout the cycle would be around 300-400 pmol/l - and HRT would aim to replicate this. However many women, especially in your position seem to have trouble feeling well even at high levels of oestrogen, and what's more become sensitive to any reduction so that symptoms re-appear at oestrogen levels which would be too high for some women. Have you tried or been offered testosterone too? You should have been. The important thing as I am sure you have been advised is not to increase oestrogen to such an extent that you get "tachyphylaxis" (sp?) which is when very high levels  cease to have the effect intended and have the reverse. With oestrogen it can happen with implants which can lead to "supraphysiological " levels of oestrogen (ie higher than would occur normally). 864 is very high but within normal range for the peak of the menstrual cycle but only intended for those suffering from depression I understand. I'm not sure of the long term effect of maintaining levels as high as this all the time and for the rest of your life - I'm not sure even that the research has been done. Prof Studd talks about this a bit on his website here: http://www.studd.co.uk/implants.php

It may be that eventually you do need to reduce your oestrogen to a lower level - but you may suffer symptoms in the meantime. I am no expert on this and obviously professional advice is needed from a gynae.  Maybe someone else in your position will be able to advise on here. I presume you are seeing someone at a meno clinic or hospital?

Definitely look into some testosterone because fatigue and headaches are symptoms of its deficiency - as well as muscle aches and pains especially after exercise - in addition to the more obvious one of low libido. There is info on this website about the role of T and especially after your operation:
http://www.menopausematters.co.uk/aftermeno.php (scroll down)
http://www.menopausematters.co.uk/testosterone.php

Hope this helps and do keep us updated...

Hurdity x

[Dancinggirl]

As always, Hurdity has given an excellent post with sound advice.  I would just like to add: do get some bloods done to look at thyroid function, Vitamin D, B12 and iron levels etc. as deficiencies can contribute to low mood, anxiety and fatigue and can be corrected with diet and occasionally supplements. 
I am personally not convinced that high levels of oestrogen alone will solve all these issues - one needs to look at the whole picture, which sadly our doctors are not good at.  Dg x

[Lucy34]

Thanks very much for your replies! I will take both of your advice.

I am on testostetone too, I had an implant a few weeks ago for the first time. I do have regular blood tests as I have Crohn's disease. I have B12 injections every 12 weeks.

I'm going to try a lower dose of the Oestrogel I think and see how I go, I think the flutuations are what make me so unwell. I had PMDD before my op. Forgot to say, yes I had my ovaries removed too.

It's so hard to know what to do isn't it! I'm glad I've found this forum, thanks for welcoming me! Xxx

[Dancinggirl]

One of my sisters has Crohns and the other Ulcerative colitis - these are debilitating illnesses that will bring chronic fatigue due to poor absorption of nutrients in your diet. Any drugs you take for these conditions will also have awful effects. HRT can actually help with Crohns I believe - it can have a positive effect on the gut and bowel generally.  It takes time to get the balance of hormones right so do persevere - at your age you really need oestrogen to protect your heart and bones for the long term, particularly if you have Crohns with possibly some restrictions on your diet because of this condition.  I would really add in some Vitamin D as it is easy to be deficient in this vital vitamin. DG x

[Lucy34]

Thanks DG, I will persevere and hopefully the anxiety will settle. I know it can take a while to find the right combination.

Sorry to hear both your sisters have a form of IBD. They aren't nice diseases at all. I am always exhausted and have been diagnosed with M.E too. Hopefully the HRT will help with it all.

Thanks again, Lucy xx