Hi heavenlyblue - don't be annoyed with yourself. The NHS is wonderful but there is very patchy knowledge about menopause and HRT – and that is why we have to educate ourselves when we encounter problems. Hence this website and helped by the forum too – so that women can feel empowered to challenge their GPs.
The fact that you still had hot flushes on the Evorel conti would normally indicate (if no other medical explanation) that your oestrogen levels were insufficient for you and therefore an increase in dose would be advised - without needing a blood test. As Evorel conti only comes in one dose your doc would either have to prescribe an extra oestrogen patch (eg 25 mcg) off licence or you would need to take separate oestrogen and a progestogen. Your GP should have been able to prescribe you something different on this basis but for you this did not happen.
As discussed on this forum and many websites etc women do not need to have hormone tests and many women on here have never had them. Except under some particular circumstances docs should go by symptoms. I realise it seems to be normal practice with private GPs - but of course is extra expense! As you probably know estradiol levels vary from hour to hour and day to day so only give a snapshot of the levels at that particular moment. As you are on patches I wonder when was the blood sample taken in relation to when you last changed the patch? On pacth change day mine were surprisingly low but mid-patch they were double and approx the range I would expect However it is interesting to see them...
Even allowing for some variation that is undoubtedly a low estradiol result but as you were still getting flushes on the dose of oestrogen you were taking – you probably knew that anyway – ie that you needed more oestrogen.
I or someone else may have mentioned on your other thread (haven't gone back over it all) that the migraines and fatigue could be down to low oestrogen but also the continuous norethisterone can cause these symptoms - headaches and migraines in some women and progestogens have a sedative effect at best, and depressing exhausting effect at worst, when taken all the time. As far as I know this does not affect oestrogen levels though - just has a negative effect of itself - but can also interfere with the beneficial effects of oestrogen in some respects.
Progesterone testing is unnecessary - it is always low in post-menopausal women. It is normally only used to test fertility so I'm not sure why this one was included?
Some gynaes suggest that testosterone tests before replacement are also deemed unneccessary and inaccurate because they are not sensitive in women whose levels are very low because the test is designed for men with lack of libido being a more reliable indication - especially if older, and if you are not on oral HRT nor taking ADs. However your low result does confirm that although low libido is the clincher! ideally once you have started the testogel T levels (along with SHBG) should be tested after a few months to make sure they are within the physiological range for women - and should then be higher!
Great that you are increasing oestrogen and have been prescribed testogel (presumably the 1% sachets?). I presume you will be taking progesterone ie utrogestan? Have you been prescribed this cyclically or continuously? Although continuous combined HRT is the norm for post-menopause I would strongly suggest you try oestrogen only for a few week and then introduce utrogestan cyclically for 12 days monthly or whatever your consultant has suggested. Downside is you would have a withdrawal bleed but only then will you know how you feel on oestrogen only?
I find it somewhat shocking that your private GP has not interpreted your results and expects additional payment in order to do so! I would have thought as least a basic explanation should be provided now you've gone to all that expense!
Anyway – you've now taken action to improve your health! Hopefully you are on the road to feeling a lot better, and can get any future prescrptions on NHS. I presume your private GP will write to your own GP with the recommendations and prescription?
These are just my thoughts - but obviously you should be guided by your docs.
Good luck and let us know how you get on!
Hurdity x
Firstly, thank you so much for taking the time to send me such a detailed post. Really helps to have things explained so fully.
What a morning, I have a 12 hour BP monitor strapped to me at the moment. Very frustrating, can't get my oestrogen upped until my BP comes down! I asked the private GP to do a letter to my NHS GP, to keep him in the loop, so she has done one and emailed me a copy, with the hormone test results so I am taking them with me on Monday, just in case they haven't been received, when I see him to get the BP results. I hope I can get future prescriptions on the NHS. I haven't had an NHS referral appt yet, so shall tell him that I was recommended this private GP so decided to see her.
Re the blood sample, it was taken on a Tuesday morning, I change my patches on a Monday and a Friday.
She has prescribed me Evoril 50mcg patches (not in stock yet) and 100mg Utrogestan capsules, which she has instructed that I take each night. I understand what you are saying about not taking the Utrogestan all the time but I feel loathe to go against the Private GPs instructions, initially. But at least if I don't feel any better after a few weeks, I can tell her I would like to try taking the Utrogestan cyclically.
Re the Testogel, I am not sure what the strength is, the chemist has my script. But they are sachets and I have to put a thumbnail on lower abdomen or outer thigh. One sachet should last 7-10 days. My Private GP had to ring the Chemist to say she was ok for me to have an unlicensed product. She said it's the first time she has ever had to ring a Chemist, she couldn't understand why the Script wasn't enough. That should be in stock by Monday. Should I start taking that now, whilst I am still on Evoril Conti, or wait til I start my new regime?
Re self help, I have gone 3 weeks without a migraine, which is a record this year! Saw a Herbalist just over 3 weeks ago. She went through my diet and we had a long chat about what was going on in my life. She went through my supplements, gave me a tincture and asked me to try eliminating wheat & keeping my sugar low. Which I have. It's no effort at all. Wheat free is not the same as gluten free so it's quite easy to do. So not sure whether any of that is responsible for not having a migraine for 3 weeks but I will stay with it! :-)
Thank you Hurdity, your advice and all you ladies are on here, is really invaluable to me. Both of my sisters are coping pretty well with it, have hot flushes but don't feel they need HRT. I don't know anyone else going through it and even though my other half has been amazing (deserves a medal these past 3 years!), it's not the same as sharing with people going through the same thing :-) Just want some semblance of that 49 year old me back...…….