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[matildamouse]

I am 53 and 2 years post-menopausal. Initially had some breakthrough bleeding when commenced HRT last year which has totally settled now for the last 7 months. Scan showed multiple fibroids in March. Next due in Dec as now on alternate days of vaginal progesterone and Estradot patches with twice a week vagifem.  Started on 25mcg which was not adequate to control flushes; new GP increased to 37.5mcg and then 50mcg as her words were " you are too young to only be on 37.5mcg". I am 63 and on 75mcg". She mentioned all the added benefits of estrogen regards bone health, brain health etc. She is very pro-BHRT and uses it herself at age 63. She specializes in women's health and I feel she knows her stuff.

When I increased to 50mcg I had breast tenderness, a few hot flushes and excessive vaginal secretions with a slight headache.We were on holiday and my husband said I was a bit "hyper" with lots of energy!  . I perservered for about 2 weeks, but symptoms remained and then decided myself to first snip a bit of the 50mcg patch (around 44mcg) and then cut back to 37.5mcg. (50mcg patches out of stock and still had 37.5mcg so that influenced my decision big time) Since being on the 37.5mcg the last week the odd recurring flushes (on the 50mcg) stopped, breasts OK and vaginal secretions normal.

So made me wonder if even at my "young age" (53 ) the  37.5mcg with the twice weekly vagifem might be sufficient for me?? The plan was to have me one month on the 50mcg and then to introduce testosterone gel which I am very reluctant to do. Reason being I had increased facial hair on Tibolone a year ago but since then my testosterone levels dropped quite low. But I did NOT cope at all with having stubbles by lunchtime so ceased the Tibolone which in all other areas worked great!

Opinions on my theories please.....Should I have persevered with the 50mcg until the symptoms settled in order to gain the added benefits and then add the testosterone? I know it is speculation and we all differ...My GP is on long leave atm.

[Hurdity]

Hi matildamouse

If you are younger than the average age of menopause (of 51/52) then it is important to have oestrogen in a reasonably high dose - that eliminates your symptoms and makes you feel good. This is where age comes in. The younger you are the higher dose should be used I would have said - for women who have eg premature menopause.

The problem with oestrogen replacement is that during the menstrual cycle oestrogen levels cycle between a baseline level and a very high level just before ovulation. I did read somewhere that HRT should aim to replace oestrogen at the average level through the cycle so this would be higher than (your) baseline - if you knew what that was - but much lower than the peak. Some women on here though, are replacing oestrogen to a very high level indeed.

In terms of absolute amount - a 50 mcg patch is the minimum dose licensed for the prevention of osteoporosis. While all added oestrogen confers some benefit - this is dose dependent so more women/great protection at this dose.

Other than this (re the average age of menopause) I would say yes it is definitely age not stage***! 75 mcg is quite a high dose for someone of my age although I did increase mine a few months from 50 mcg to 62.5 because of adding testosterone. Remember that the absorption of oestrogen varies enormously between different women so you may well be getting a decent amount at 37.5 mcg! Only a series of blood tests would tell you - but I'm not sure these are necessary if you are feeling well.

Re increasing to 50 mcg - personally I would try to persevere a bit longer with this - maybe by snipping bits off so that your increase is gradual - and certainly would want to be at least on this dose (notwithstanding what I said about differential absorption amongst different women!) before adding testosterone. I would give it a month - and increase gradually.

Hurdity x

*** later edit - I think I meant stage not age but age does come into it!!!

[Dawncam]

Hi Matildamouse - as is evident from the experts, symptoms are the all important marker. Because of some oestrogen nazis on this site, I tried to reduce my dose even though my (probably the most eminent) specialist told me to increase. I've now increased to the dose he told me and I feel great. I'm now on approx 2.5mg oestrogen in gel form.

They're specialists in their field for a reason!

Maybe you could try a different delivery system - I much prefer gel to patches and others are vice versa. You're really lucky to have such an enlightened doc - maybe go back and chat to her about your concerns/options.

Good luck

Dxx

[Dawncam]

Hi matildamouse - apologies just re-read your post and realise your doc is not available just now. Maybe it's the vagifem causing excessive secretions and you could reduce that a little whilst staying in a protective level of systemic E?

Dxx

[Hurdity]

Because of some oestrogen nazis on this site, I tried to reduce my dose

Dxx

Goodness - that's a bit strong Dawncam - what do you mean and who on earth are you referring to? I haven't seen evidence of this although some women are adamant that we should all have oestrogen levels of 600-800 pmol/l - but not said in a particular dictatorial way!

Different women are advised differently according to their specialists and their age and stage.  However if you look at Prof Studd's website - he recommends attaining levels of 300 pmol/l for improvement of bone density in most women ( I imagine most women will attain less than this on a 50 mcg patch though!), but very high levels 800 pmol/l for those suffering from reproductive depression including PND, and laso recognises the complex relationship betwene actual levels and symptoms - which is far from straight-forward. He also warns against tachyphylaxis from implants.http://www.studd.co.uk/implants.php

If our treatment is through a gynaecologist then s/he should be the person to listen to - but of course sometimes even they differ in advice and it's always good to hear what other women have been advised or are taking!

Yes I think it goes without saying that definitely symptoms should be a guide but often this is not always straightforward. In terms of patches - I would always say that a minimum of 50 mcg should be aimed for if possilbe ( and higher if needed naturally!) - although I have no experience of gel - but it does seem some very sensitive women even have a problem with increasing at all - although this can be mitigated by increasing in very small increments.


Hurdity x

[Dawncam]

Thank you Hurdity - it would be indelicate of me to start tittle-tattling and finger pointing.  This forum is to inform and support, not prescribe and I've found the latter happening on too many occasions.

I'm very aware of Prof Studd's views on HRT as I am a patient of his. I believe you are not?

Having mistakenly followed some of the ill-considered 'advice' available here, I will in future ensure that I only ever follow my specialist's prescription as it's impossible for a lay person to understand the effects of myriad treatments on such a variety of women.

Dxx

[Dawncam]

Haha - menomale my late father was a feral teenager his entire life!

But that's men - too much T - lucky them!

Dxx

[Dawncam]

Ooh menomale - not sure what that is but it sounds intriguing!

Dxx

[Dawncam]

Couldn't agree more. Who could survive this crazy planet without some chemical help?

T it is then!

Dxx

[matildamouse]

Thanks Hurdity, I might consider sticking on the 50mcg patch again and snip the corner initially until I feel more settled on a 50mcg dosage. That is if I can get hold of the 50mcg patches!!

Dawncam, I can not use gel as my cat became very ill when she was accidently been exposed to the gel when I initially used that. I love the patches as I feel it gives me a much more consistent dosage as oppose to the gel.

[Dawncam]

Sorry to hear about your cat matildamouse and good luck with the snipping.

Dxx

[Hurdity]

Thanks Hurdity, I might consider sticking on the 50mcg patch again and snip the corner initially until I feel more settled on a 50mcg dosage. That is if I can get hold of the 50mcg patches!!

Dawncam, I can not use gel as my cat became very ill when she was accidently been exposed to the gel when I initially used that. I love the patches as I feel it gives me a much more consistent dosage as oppose to the gel.

This is what other members have done in the same circumstances....I hope it goes well - I have always been happy with these patches . Re your poor cat - yes one has to be careful with gel application - with animals and partners.

Hurdity x