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[Anna69]

I have been on estradiol (Oestrogel) and Utrogestan 200 mg for twelve days a month for the last three years (I'm 50). A year ago, after my periods stopped, I went from using Oestrogel day 5-25 of cycle to daily (two pumps/day). Increasing it to three pumps per day as suggested by my doctor has not really helped.
Lately, I've noticed symptoms such as increased sweating, especially at night, and waking up several times every night drenched in sweat. Even if it's snowing outside, I need to have my bedroom window open.
I have read that many women are not estrogen deficient but dominant, even in menopause, as progesterone levels fall much more dramatically than estrogen levels. But not sure how to decide if that is an issue in my case.
My latest labs are from February 2020. Since I no longer have a cycle I can have them done on any day of the month (as opposed to earlier when I was supposed to go to the lab on day 21 of cycle). I had labs done during the twelve day period I'm also on Utrogestan.
Results:
estradiol 37 pg/mL (ref menopause <28)
progesterone 1.0 ng/mL (ref menopause <0.2)

But these reference ranges I assume apply to women who are not on HRT. I think my results look rather low for someone on HRT?
My SHBG came back at 95 and, although in range, I've read it should not be higher than 75.
Not sure if there is a connection, though.

It would be interesting to know if anyone has used progesterone only rather than E + P to deal with problems such as hot flushes?

[Sammiejane]

hi

my estrogen level is 435 pmol
shbg was 115

so not sure to be honest if mine ok or what i?m awaiting a telephone appointment with gp to discuss and all routine appointment have now been suspended due to the corona virus

sorry not much help

[Sammiejane]

hi

i think you estrogen is to low

i use 2 pumps gel to my arms and 100mg progesterone daily

and my estrogen was 435pmol which is i think 118 pg/ml so good levels
and progesterone is 10
but i feel i need more estrogen or testosterone 

[Hurdity]

Hi Anna69

Oestrogen dominance is one of those myths..... it is only relevant in terms of peri-menopause when ovulation becomes more sporadic but the ovaries are still pumping out oestrogen. The anovulatory cycles which result can lead to thickening of the womb lining due to insufficient progesterone - hence the "dominance". Provided your womb lining is kept within normal limits by the progesterone dose and you do not have breakthrough bleeding then the balance is right.

You didn't say where you were in menopause when you started the hRT - whether your periods were still regular or already few and far between? This will give a clue as to your menopausal status ie whether post or still peri. Following the last ovulation ( and once you start HRT you won't know when that is) oestrgoen levels continue to fall quite dramatically over the next 2 years at least and maybe more so some women find they get a worsening of symptoms around this time. You flushing could be due to this.

This is probably borne out by your oestrogen results although blood tests are somewhat inaccurate. (Sammiejane the units of measurement are different so your results are not comparable with Anna's).  I'm guessing you're not in UK as we measure here in pmol/l and also don't do "labs"? So your estradiol is approx 136 pmol/l which is still quite low (but higher than someone not on HRT and post-meno). I suggest you increase your dose if this is approx accurate reading and in view of your symptoms, after consultation with your doc.

Progesterone is unimportant - no need to have this measured except for fertility purposes as it is meaningless. There is no meaningful ref range once you're on HRT or post-meno. Like I said if your womb lining is normal and no bleeding then it's fine.

SHBG on its own also is not very meaningful. Would need to know units of measurement and lab range. Also usually measured in conjunction with total testosterone (in the absence of tests for free T) to give female androgen index.

I gather there is some evidence of progesterone being used for flushes but only in very high doses ie used as a pharmaceutical drug rather than as a replacement horomone - far higher than anyone would use for HRT. With your oestrogen being lower than ideal I would suggest you go for increasing this. Perhaps half a pump at a time?

All the best and hope you sort your symptoms

Hurdity x

[Anna69]

Thank you all for your input, very helpful!

Sammeljane, which brand of gel are you on? I am on Oestrogel (Besins Healthcare) 0,6% and it says in the PIL that each pump delivers 75 mg of estradiol. A friend of mine is on Lenzetto where each pump (or rather spray) delivers 1.53 mg of estradiol, so maybe asking my doctor about switching me to Lenzetto would be a good idea?

I was put on HRT seven years ago, at age 43, by a so called anti-aging doctor in Belgium (I'm in the Netherlands BTW). I was still having regular periods at the time, but those doctors use optimal age-dependent ranges and I was told mine were far from optimal...of course, by then, I would have been peri-menopausal, so more likely E dominant than E deficient, but it seems I still needed estrogen...at least I did not have any problems until the last few months, so it would seem my estrogen levels have dropped to levels where I am deficient.

I am also hypothyroid and on thyroid hormone replacement which possibly also plays a role when it comes to sex hormones?

I have read that you can use up to four pumps of Oestrogel (0.06%) daily, so that could also be an idea (two am, two pm)?

Interesting what you say about progesterone...some alternative practitioners claim it should be used to counterbalance estrogen dominance, as they claim we are all estrogen dominant due to plastic bottles, cosmetics, traditional farming methods, etc. But I do seem to need estrogen as well.

Maybe it would be a good idea to take progesterone daily instead of cyclically...I have read that it is better to take it cyclically as the body only produces high amounts of P during two weeks a month, so taking it 10-12 days a month would be more natural than taking it continuously. However, it seems many take it daily and do fine that way. Are there any additional advantage to taking it daily (for instance, will that result in more steady P levels compared to someone taking it two weeks a month, or a better E/P balance)? I am not sure how to know when to take it cyclically anymore, TBH, since I no longer have a cycle. Maybe it does not matter once there is no regular cycle...?

Hurdity, those are the test results with reference ranges:

SHBG 91.9 nmol/L (20.0-155.0)
total testosterone 0.29 ng/mL 0.10-0.70)
free calculated testosterone <0.01 ng/mL (<0.01)
bioavailable calculated testosterone (Kaufmann-Fiers formula) 0.06 ng/mL (<0.25)

I discussed my testosterone levels with my doctor at my last appointment back in October 2019, but she said that since I have facial hirsutism I should not supplement it (she prescribes Testim to T deficient patients). I cannot understand where it is coming from but have spent a month's salary so far on electrolysis (so painful that it amounts to torture but said to be very effective). I was diagnosed with ovarian cysts two years ago but was told they did not need to be treated and would most likely disappear once menopausal. They never caused me any symptoms. I understand that is not the same thing as PCOS, where androgens are elevated, and that my testosterone levels are quite low...so not sure why the facial hirsutism? I have always had this problem (I used wax for years), but it has got a lot worse in the past few years so I guess menopause plays a role...

I understand estrogen can suppress testosterone so leading to sex hormones imbalance...not sure how to interpret my T levels, though, so any input would be appreciated. My doctor merely seemed concerned with my hirsutism, she did not say my T levels were good, but I have had hirsutism all my adult life without any idea what  my hormone levels looked like.

[Hurdity]

Hi Anna69

The Lenzetto dose will have been worked out so that the standard medium dose is comparable with the standard medium dose of gel so I am assuming the Lenzetto is better absorbed ( from test results) as 2 pumps of gel contain approx the same amount ( as 1 spray).

Yes there is an interaction with thyroid function and sex hormones but it's complex!

I don't really know about the hirsutism. Like you say it is a symptom of PCOS but you have low T. Your testosterone levels do seem very low indeed, as does the female androgen index if those units of measurement are correct, so despite the hisrutism you may want to supplement but I would want to know what the cause is first. What is your libido like and what has it been throughout your life? Strange to have cysts on your ovaries and hirsutism but apparently low T. I would ask for repeat tests from standard lab equivalent of NHS ie Govt not private - I presume they were blood tests?

As for the progesterone stuff - I would ignore the alternative practitioners. All that stuff about "balance" is pretty much twaddle! And the xeno-oestrogens meaning you need progesterone. It's all designed to sell progesterone cream!

In terms of taking it cyclically or not, it depends on your own make-up - whether you tolerate it or not so it's a perosnal thing. Some of us posting on here don't like the side effects, so take it cyclically. It's nothing to do with balance. The only need for balance is to protect your womb lining. You just need to take the right dose of progesterone whether cyclically or continuoulsy that keeps your womb lining within normal limits so the choice is up to you.

Sounds like an increased dose would be good if you are still getting flushes with 2 pumps. Some prefer to split the dose to am and pm but I have no experience of this.

Soirry I can't be more helpful.

Hurdity x

[Anna69]

Hi Hurdity,

Your reply was very helpful indeed.

My libido has never been that strong, not even in my teens or 20s, so not sure that is a good indicator.

My gynaecologist told met it is quite common to develop ovarian cysts in the years leading up to menopause but that they do not warrant treatment if you are not bothered by them and they do not cause any symptoms.

Interestingly enough, the only thing that has enabled me to lose weight (I was diagnosed with insulin resistance a few years ago) is a supplement called Hyponidd which has anti-diabetic properties but also lowers androgens so used to treat PCOS. I then stopped it because I was afraid it lowered my T levels too much, but wonder if I should go back on it again as it really helped lower my fasting blood sugar and insulin levels.I have had a much harder time keeping my new, lower weight since going off it. I have tried berberine instead but it just does not seem as effective.

[Sammiejane]

hi

i agree with hurdity to a certain extent re progesterone i think it's individual for me i am much better balance on e and p even though i don't need p plus i have less bloating no sore boobs but last increased to 3 pumps as felt the p was slightly outweighing the e in that my skin was dryer mouth dryer and vagina but 3 pumps was to much knew instantly this morning so going for 2. 5 but this is for me what i?m finding working but still early days but on the gel alone i was crazy so i use estrogel 2 pumps applied to arms and have had better obsorbtion on my arms then when previously used on my thighs x

[Babibell]

Thank you all for your input, very helpful!

Sammeljane, which brand of gel are you on? I am on Oestrogel (Besins Healthcare) 0,6% and it says in the PIL that each pump delivers 75 mg of estradiol. A friend of mine is on Lenzetto where each pump (or rather spray) delivers 1.53 mg of estradiol, so maybe asking my doctor about switching me to Lenzetto would be a good idea?

I was put on HRT seven years ago, at age 43, by a so called anti-aging doctor in Belgium (I'm in the Netherlands BTW). I was still having regular periods at the time, but those doctors use optimal age-dependent ranges and I was told mine were far from optimal...of course, by then, I would have been peri-menopausal, so more likely E dominant than E deficient, but it seems I still needed estrogen...at least I did not have any problems until the last few months, so it would seem my estrogen levels have dropped to levels where I am deficient.

I am also hypothyroid and on thyroid hormone replacement which possibly also plays a role when it comes to sex hormones?

I have read that you can use up to four pumps of Oestrogel (0.06%) daily, so that could also be an idea (two am, two pm)?

Interesting what you say about progesterone...some alternative practitioners claim it should be used to counterbalance estrogen dominance, as they claim we are all estrogen dominant due to plastic bottles, cosmetics, traditional farming methods, etc. But I do seem to need estrogen as well.

Maybe it would be a good idea to take progesterone daily instead of cyclically...I have read that it is better to take it cyclically as the body only produces high amounts of P during two weeks a month, so taking it 10-12 days a month would be more natural than taking it continuously. However, it seems many take it daily and do fine that way. Are there any additional advantage to taking it daily (for instance, will that result in more steady P levels compared to someone taking it two weeks a month, or a better E/P balance)? I am not sure how to know when to take it cyclically anymore, TBH, since I no longer have a cycle. Maybe it does not matter once there is no regular cycle...?

Hurdity, those are the test results with reference ranges:

SHBG 91.9 nmol/L (20.0-155.0)
total testosterone 0.29 ng/mL 0.10-0.70)
free calculated testosterone <0.01 ng/mL (<0.01)
bioavailable calculated testosterone (Kaufmann-Fiers formula) 0.06 ng/mL (<0.25)

I discussed my testosterone levels with my doctor at my last appointment back in October 2019, but she said that since I have facial hirsutism I should not supplement it (she prescribes Testim to T deficient patients). I cannot understand where it is coming from but have spent a month's salary so far on electrolysis (so painful that it amounts to torture but said to be very effective). I was diagnosed with ovarian cysts two years ago but was told they did not need to be treated and would most likely disappear once menopausal. They never caused me any symptoms. I understand that is not the same thing as PCOS, where androgens are elevated, and that my testosterone levels are quite low...so not sure why the facial hirsutism? I have always had this problem (I used wax for years), but it has got a lot worse in the past few years so I guess menopause plays a role...

I understand estrogen can suppress testosterone so leading to sex hormones imbalance...not sure how to interpret my T levels, though, so any input would be appreciated. My doctor merely seemed concerned with my hirsutism, she did not say my T levels were good, but I have had hirsutism all my adult life without any idea what  my hormone levels looked like.

Just to let you know I also have multiple ovarian cysts since my 20s, hirtuism since then and zero T on tests! I take T daily now.

[Tc]

My gynaecologist told met it is quite common to develop ovarian cysts in the years leading up to menopause but that they do not warrant treatment if you are not bothered by them and they do not cause any symptoms.

Hiya annie 69.

I hope you dont mind comnenting on this. I Just wanted to say the vast majority of cysts are indeed benign but not all benign cysts are the same.

Functional cysts are part of the way the ovaries work in fertile years..  they can be problematic in particularly in certain conditions but usually benign and usually resolve spontaneously.

There are also many types of non functional cyst and the vast majority of these are also benign and dont necessarily  require treatment unless large or causing symptoms or affecting ovarian function.

Post meno  the growth rate can indeed slow down, stabilise or even shrink for some types of cyst... but not for all.   Dermoids for instance do not resolve in fertile years and do not get smaller post menopause. Size is a considerstion in benign cysts because there is an increased risk with large cysts of rupturing  or causing torsion.  Both these situations are a medical emergency.

I  feel It's important that any new post meno cysts are investigated. Functional cysts are not common post meno. I stress again that statistically the majority of non functional cysts are benign but it would be remiss of me not to mention that some types albeit a relatively small number are not.

a trans vaginal scan  is initially used to look at cysts.  Many require no action. . if size is a consideration it may be monitored. If there are any doubts about the features of a cyst at trans v then follow up should be done.  further tests may be carried out and a risk assessment may be done to decide management of the cyst.

Again, I hope you dont mind me saying this but I feel it's worth saying.

Xx

[Kathleen]

Hello ladies

Regarding cysts my MIL had a large cyst removed when was 63. It had caused some pain and she was scheduled for a hysterectomy however it suddenly became twisted and she needed emergency surgery. It was only after her operation that she was told it was benign and it weighed 9 pounds! MIL was always overweight despite constant dieting and exercise but she had few menopause symptoms and never needed HRT. My own mother was small and slim, never took HRT but also had a  hysterectomy at 50. She had fibroids which  caused  flooding and a benign ovarian cyst the size of an orange.

Take care ladies and stay safe.

K.

[Anna69]

Thanks to all who replied!
My gynaecologist does a pelvic scan every time (I see her every three months), and if one cyst has disappeared on the right ovary another one has appeared on the left...but the number and size of cysts are pretty constant. The doctor does not consider any treatment necessary at this point.
As for possible PCOS, I have read that the most telling symptom is irregular or absent periods, and that is why this condition is often discovered when a woman is treated for infertility. My periods have always been regular. Heavy, horrible, yes, but always regular. That combined with the fact that I have low testosterone levels would more or less rule out PCOS, wouldn't it?
However, someone on a thyroid forum suggested some of my symptoms (restless sleep, increased resting pulse, high blood pressure, recent weight gain, diagnosed insulin resistance) could be indicative of high cortisol. So I ordered a 24 h saliva test and have been waiting six weeks for the results. They finally arrived. And they show slightly elevated cortisol throughout the day (samples from 7.30 am, noon, 4 pm and 11 pm (bedtime)). I read that excess cortisol levels can also cause hirsutism, along with all my other symptoms.
A few years ago, my functional doctor diagnosed me with adrenal fatigue and put me on hydrocortisone (20 mg daily). Back then, it seemed like an easy solution, but now I am not so sure...after a couple of years on it, I was afraid about long-term side effects so weaned myself slowly off it. But it seems that although it's common for steroids to suppress adrenal function, they can also overstimulate the adrenal glands in some patients? I have not taken HC for almost two years, but my cortisol levels are still slightly out of range...
So I am thinking the hirsutism is more likely caused by highish cortisol levels rather than high T as my T levels have always come back in range, but slightly low in range, but never even close to the upper normal range...apart from the annual blood tests, I also had a 24 h urine analysis when I first consulted the function doctor. This revealed low thyroid and sex hormone levels.

[Kathleen]

Hello aga ladies

Anna69. - I am not sure how relevant this is but when I was given steroids for an autoimmune disease I was told to take them for as shorter time as possible and to wean myself off them gently.  It seems that when the body detects extra steroid hormones the adrenal glands down regulate their production. If we suddenly stop taking the meds the adrenals can't make up the shortfall quickly enough and we can become very ill.

I expect your situation is different but I wanted to mention my experience with steroids just in case it is helpful.

In December last year I developed hypothyroidism and was put on Levothyroxine (T4) and my thyroid levels are now in the normal range. Perhaps check your results to make sure that your low thyroid is not being properly controlled.

Take care.

K.

[CLKD]

Saliva tests prove nowt.  Did U pay for it?  I don't think the NHS provides this type of testing?

Cortisol is the waking hormone. It gave me dreadful problems when I was depressed - from 3.30 a.m.  .........  where did you read the info about cortisol  . 

My Mum had polymyagia-rheumatica and was treated with steroids, her body swelled for a while.  She had to be weaned off under supervision, steroids are not drugs to play around with but used correctly, can enhance the body's coping mechanism.

[Anna69]

I'm not in the UK, but ordered the saliva test from a UK laboratory (Genova Diagnostics). And yes, I paid around 130 GBP for this analysis.
I have read about cortisol issues on many sites...to name but a few: Stop the Thyroid Madness, Thierry Hertoghe's website www.hertoghe.eu, TPUK, Amy Myers, Westin Childs (functional US doctors)...also, British doctor B. Durrand-Peatfield mentions it in his book "Your thyroid and how to keep it healthy"...but he advocates using hydrocortisone for a very short time....a few weeks or maybe a couple of months. I stayed on it for two years and would still be on it if I had not weaned myself off it. I just did not feel comfortable staying on it any longer after reading about all the potential side effects...even on a so called "physiological dose"...
When I compare photos pre- and post-cortisone I can see that I have a much more "androgen" look now...which is a bit surprising considering my testosterone levels are well within range. But my face is now more square than oval (much more pronounced jawbone...related???), and I have been fighting to get rid of this "mustasch" for years...also a sign of PCOS/too much male hormones according to my sources. Plus, my skin is so oily it is shiny, and I have been trying to remedy that by buying all sorts of skin care products. So far, without any luck.
I guess this is all about the chicken and the egg...in my teens, in the mid 1980s, I had terrible sugar cravings which I gave into. I spent the next 20 or so years yo-yo-dieting...up 30 kgs, down 30 kgs, up 20 kgs, down 20 kgs...and so on and so on. Every time I saw a doctor I was told that I was "chubby, but not alarmingly so", and that things would normalise once I went on low fat diet and started exercising...although I was working out like crazy.
When I was 21, I went to see a doctor to get birth control pills because I could not stand my periods. They were not painful, but horribly heavy, and would last for +/-10 days...the doctor checked my blood pressure and said that, since it was borderline hyper, she could not prescribe the drugs...I spent the next ten years dieting, losing weight, gaining weight, losing a little less weight, gaining even more weight...until I was diagnosed with hypothyroidism (Hashimoto's) in my late 20s. Thyroid hormone replacement resolved some symptoms, but far from all.
My whole life, I have had borderline high blood sugar and insulin, but was told it would all go away "once I was on a low-calorie diet and exercising enough". In the years since, I have sometimes exercised to the point of ending up exhausted (jogging for up to two hours a day) without getting any results, while doctors told me I should "get my act together and start moving".
Looking back, and having read all the books and articles that I have now (written by patients or functional doctors), I am asking myself this: in my teens, did I start to overeat high carb foods because I lacked character, or simply because I was suffering from some hormonal disorder already in those days, causing blood sugar disorders...? Of course, there is no way of telling.