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[vintagefiend]

Hi there,
I'll start by saying that I know we're not supposed to obsess over readings but please humour me!
i'm on HRT
my venous oestradiol is 150 p/mol- this was a private test- the doc at the company has stated it's within normal range but when i look at the range, it's very much on the lower side.
I've just turned 48 so feel that i should have good levels and, anyway, i'm damn certain i'm experiencing low oestrogen side effects- so i'm a bit pissed off that the doc glibly states that levels are fine.
I started two pumps oestrogel about 3.5 months ago and initially it did wonders for my mood- I was soooo very depressed and it was amazing.
But, the depression's come back- I feel awful and have some other likely symptoms of low oestrogen which were all initially eradicated by the oestrogel- hair falling out, acid reflux, utter exhaustion- (I'm on snri antidepressant which happens to control flushes- so i don't experience those, but quite possibly would otherwise!)
I have tentatively tried upping the dose (by half a pump) but actually feel worse when i do this!
However, before i even started the 2 pumps (back in June), I had been trying tiny doses: quarter, half pump and those, too, made me feel worse!! it was in desperation that i actually tried more (though it felt counter-intuitive given that less made me feel like shite!!)
But, as i say, miraculous!!
but here i am again- do i just bite the bullet and slap another 2 on (ie increasing to 4 pumps altogether) as this seemed to work before or what???!!
what is an optimal level for oestradiol when on HRT? For mood, for bones, whatever...also i am relatively young so feel i should have decent amount!
Thanks for any help 

[Hurdity]

Hi vintagefiend

I can't remember your story - do you take a progestogen of any sort? Womb/ovaries? Yes that is low if you are taking HRT but is only a spot result. More instructive are your symptoms so if you are not feeling good then maybe try to increase. having said that it's difficult if you are on ADs as well as, like you say, these mask the classic symptoms of low oestrogen such as flushes and sweats which are tell-tale signs., so you are left with the other symptoms to go on - and some of these can have other causes. There is the possibility of testosterone if you have low libido - but then this can be also cause by the ADs so tricky one that. If you have no ovaries then your T is probably likely to be low so if this is the case have you considered that? You are young to have such low oestrogen levels if these are an accurate picture of roughly what they are normally, so if you feel better adding more then with your doc's permission ( as you'll need more gel!) then why not do so, if it worked before?

There was a discussion about oestrogen levels and some links to ref ranges here:

https://www.menopausematters.co.uk/forum/index.php/topic,45602.0.html

Hurdity x

[Tc]

Hi vintage.
I have the same E level on HRT. But I have no ovaries. It's considered on the low side on HRT. And ideally should be a bit higher for bone health, But mine has been consistently low over many blood tests. . So I agree with hurdity that, depending where you are in meno and if ovaries are intact your level will possibly fluctuate and  one test result doesnt give an overall picture. Having said that  I also agree  that if your symptoms are not controlled then it would seem that level is not enough for you as an individual. 

With increasing. One piece of advice I was given by a meno nurse is increasing in increments. So dont jump straight from 2 to 4. You might feel symptom controlled at 3.  So increasing slowly avoids "overshooting the mark" so to speak. I know the feeling of just wanting to double up to just get some relief. But  if you take it gradually you have more chance of hitting the right level for you without "seesawing" up and down.  Good luckxxxx

[vintagefiend]

Thanks very much, ladies!!
oh dear- i did get carried away and doubled up and really should have read what you wrote as do feel quite jittery and sick and mood no better!
Tomorrow i will put 3 on and stick with it.
I do have ovaries and am awaiting a hysterectomy (not full) as find progestogens hard to tolerate- so need to be womb-free.
i guess, strictly speaking, i'm still perimenopausal as last period was end Jan 2019 but i really feel like i'm winding down rather than having fluctuations.
but i totally take your point about it being a spot test.
i do know that my T is also in my boots but presume i should try to feel reasonable on oestrogen first- argh! i thought i was too!
i just wish this depression would go away- i want to feel like i did when i first took HRT 
thanks for being there.

[KiltedCupid]

vintagefriend - at your age, I went from 2mg oral to 3/4 pumps oestrogel and a blob testim. Back then my level was tested by Studd about 2 hours after gel application and came back at 600pmol. I felt great but my levels started to drop as I wasn't absorbing the gel, but didn't realise it at the time and eventually plummeted to under 80pmol. My own gp will only do 1 hormone test per year so I had to go private for more blood tests. 150 is low for your age and I do understand feeling crap when trying to increase oestrogen again as it's happened to me but you should be higher. I've just remained on a 25 patch as I can't go higher without feeling ill but I'm fine on this and happier at age 57 to be on a lower dose and less prog.

Are you having the hysto because of prog intolerance?

[Hurdity]

Thanks very much, ladies!!
oh dear- i did get carried away and doubled up and really should have read what you wrote as do feel quite jittery and sick and mood no better!
Tomorrow i will put 3 on and stick with it.
I do have ovaries and am awaiting a hysterectomy (not full) as find progestogens hard to tolerate- so need to be womb-free.
i guess, strictly speaking, i'm still perimenopausal as last period was end Jan 2019 but i really feel like i'm winding down rather than having fluctuations.
but i totally take your point about it being a spot test.
i do know that my T is also in my boots but presume i should try to feel reasonable on oestrogen first- argh! i thought i was too!
i just wish this depression would go away- i want to feel like i did when i first took HRT 
thanks for being there.

What progesterone are you on at the moment vintagefiend? If you still have ovaries then yes that is particularly low given the number of pumps you are using - even if you are still having some sort of cycle. If you've been taking cyclical HRT then you won't know whether you are peri or post because the HRT interferes with this.  I presume you either have Mirena or cyclical progestogen?

Hope you feel better soon

Hurdity x

[vintagefiend]

Thanks Kilted and Hurdity-
I am supposed to be on utrogestan but have only taken it once since June- for about 7 days (100mg) vaginally so i had a "proper" period from that a couple of weeks ago but otherwise nothing- so i'm pretty confident that my last (true) period was end Jan.
my GP knows I'm doing this with the prog- i'll brace myself to do it again soonish (clear the diary!)
I've done a gazillion private oestradiol blood tests over the weeks and months and they always show post meno levels- there's never a reasonable reading!
so 150p/mol is higher than it has been with no HRT but seems it's not great on HRT.
Really useful for me to know that it's low and should be higher.
also very reassuring to know that, Kilted, you also felt crap initially when increasing oestrogel!- I'm going to persevere.
i'll also keep an eye on my levels to check absorption though it would definitely appear that my mood is a terrific indicator of this!!
yes, i'll be having the hysterectomy due to prog intolerance.
I'm actually relieved that my levels are low- i was terrified that they'd be normal and therefore i'd have no clue as to why i feel so goddamn awful.
cheers ladies- i do feel a bit better now that the initial hit of double oestrogel has eased off! and i'm really thankful for your reassurance 

[Jinja]

Might also be worth trying a patch, I didn't seem to absorb the gel very well but have been fine with a patch

Jinja

[KiltedCupid]

Might also be worth trying a patch, I didn't seem to absorb the gel very well but have been fine with a patch

Jinja

I was just about to say that Jinja. Oestrogel used to whoosh in and out of me, major peaks and dips. Now on a patch and much more steady delivery.

Vintagefriend - have nhs agreed to your hysto or is it private? I'm awaiting gynae appointment for the same reason and I'd be really interested in your experience.

[Hurdity]

Thanks Kilted and Hurdity-
I am supposed to be on utrogestan but have only taken it once since June- for about 7 days (100mg) vaginally so i had a "proper" period from that a couple of weeks ago but otherwise nothing- so i'm pretty confident that my last (true) period was end Jan.
my GP knows I'm doing this with the prog- i'll brace myself to do it again soonish (clear the diary!)
I've done a gazillion private oestradiol blood tests over the weeks and months and they always show post meno levels- there's never a reasonable reading!
so 150p/mol is higher than it has been with no HRT but seems it's not great on HRT.
Really useful for me to know that it's low and should be higher.
also very reassuring to know that, Kilted, you also felt crap initially when increasing oestrogel!- I'm going to persevere.
i'll also keep an eye on my levels to check absorption though it would definitely appear that my mood is a terrific indicator of this!!
yes, i'll be having the hysterectomy due to prog intolerance.
I'm actually relieved that my levels are low- i was terrified that they'd be normal and therefore i'd have no clue as to why i feel so goddamn awful.
cheers ladies- i do feel a bit better now that the initial hit of double oestrogel has eased off! and i'm really thankful for your reassurance 

Oo-er yes you really should do another course of utrogestan to shed that lining - even while waiting for a hysterectomy unless you know that it's going to be very soon! Yes clear the diary! If you are not absorbing though then maybe your womb lining won't be as stimulated as the oestrogen dose might lead one to expect? This being the case maybe your bleed will be light?

Hurdity x

[vintagefiend]

Hi again, ladies,

i'm def starting to feel less depressed- bloody hell! can't see myself ever being without HRT!

Jinja- that is a really good point- i may well consider a patch- i can feel the hit of more oestrogen now (literally as i type) and it's not very pleasant! i'd much prefer a more consistent dose. i wonder if estradot has been hit with supply issues?!

Kilted- i'm actually only awaiting the initial consultation but i'm pretty sure it'll just be a formality. i have seen someone privately before and they were going to refer me but i bottled it! i've "accidentally" seen a gynaecologist before when i was expecting to see a menopause specialist and he was fairly glib about a hysterectomy- seemed to be offering it to me!-but i didmt want it then- so i'm confident that i'll be able to put my case. just called to see where i'm at in waiting list and i've a long way to go before the initial consultation- ah well! good luck to you with all this.

Hurdity- I know! i'm being cavalier and it does frighten me but i feel so bad on prog- just awful! when i next go to docs i'm going to be assertive and ask for a scan.
as you say, maybe my lining isn't too bad given that i don't have very good oestradiol levels.
also my very recent prog-induced period was relatively heavy which was a relief.
but, thank you for your concern- i know i haven't taken much prog at all!

[vintagefiend]

Sorry- it's me again and i don't know if anyone will see this- but i crashed moodwise again yesterday and still pretty down-am questioning the oestrogel- for the sake of consistency i'll stick with it for a bit but do wonder if it's just going to be peaks and troughs all the way!

i'd love to know which patches you ladies are on?
thanks and if this is a bit of a "dead thread" i can always start a new one!

[KiltedCupid]

Vintagefriend - I recognise that, I had it on gel too. Sandrena was less turbulent but patches are best for me. It might be worth trying a patch to rule out the crashes with your gel delivery. Also you can split application of gel 12 hours apart to try and stabilise your dose.

I've tried all the patches and my preference is fem7 oestrogen patch. It's a weekly patch and all the others are twice weekly. It doesn't bother me if it's once or twice a week as long as it's a steady delivery. I know there's shortages of patches just now but estraderm and fem7 are still available. There's also a patch called Progynova which is rarely prescribed as it's very expensive. Worth a try if you're struggling. You can get a prescription from your doc and either source through your pharmacist or online. Good luck.

[Hurdity]

Hi vintagefiend - re the patches - I started on Evorel when i was late peri but the conti part didn't agree with me although the Evorel (oestrogen only) part was fine. Since then ie mid 2007 I have been exclusivley on Estradot so was very reluctant to part with them in view of the current shortages! However no choice so dispensary gave me Estraderm which I have been on for just under a month now I think. Surprisingly i feel absoutely fine on them so far (fingers crossed) so if you can get these then great although they are very large so feels like a plastic bag attacehd to my butt after the minute Estradot!

All of these are twice weekly patches but I now change them every 3 days (for about the last 6 months or so). Personally wouldn't want to take the once a week patches re sticking issues , baths, jeans etc etc but of course many women love them as can forget about them. Sometimes i wonder how the oestrogen  levels remain high after a week and whether there is more of a dip with the 7 day ones - especially if they come slightly unstuck - haven't looked up the info though!

Hurdity x

[vintagefiend]

brilliant!
thanks you so much, ladies- i feel armed with information!
i think in the meantime i will split the gel- it's certainly reassuring to know that i'm not the only one to experience this with oestrogel.
by far the best i've felt this week is the evening after the 4 pump morning dose-after feeling initially quite battered by it, i felt so calm and normal- slept like a baby and woke up feeling good. then applied 3 pumps and not great since then.
i know i'm analysing to the max and that it's v early days in terms of the increase and i guess my body is adjusting and recalibrating constantly.
i hold on to the fact that i did at one point feel gloriously normal so i should be able to recapture that