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[Teresa]

Hi All,

I had a blood test last week to determine my Estrogen level via a blood test after being in continuous HRT of utrogestan ( orally) and Evorel 50 ( and Estradot 50) Estrogen patch, for nearly 2 months - before that I was on a dual pill, for a month. I have been getting darker hair on face, thinning hair, greasier skin and anxiety not improved, though hot flushes and sleeping had improved.

The Estrogen ( estradiol E2) results came back as 105 pmo/L, which indicated they were still below the highest level for a post menopausal woman. Yesterday, I spoke to my GP on the phone to discuss. I had a rather confusing conversation, where he backtracked on the fact that he should have sent me for a blood test in the first place and he also said that the Evorel, or even the Estradot patch hormone does not show up on hormone blood tests as it’s a different type of hormone and not the one they test for at labs. I did ask that I thought as it was body identical that it was the same, but after reading something, while I was on the phone ( it sounded like he was googling  ) he said it wasn’t. He said that he is supposed to up HRT patches based on how ‘I feel’ . My GP is lovely, but I do feel that he often doesn’t know too much about HRT which is why I am a bit weary.

In the end he did up the patch to a 75….but I’m now wondering how do we ever know for sure? Is it always upped on how we feel? So body identical HRT isn’t really ‘identical’? How will I ever know my true reading?

Has anyone else been in same boat?

Thankyou in anticipation,
Teresa
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[Floo36]

The Estrogen in the patches are body identical so just like our own.  Your symptoms I also have and are  due to Estrogen deficiency and imbalance.  If you are in peri then it is difficult to know with blood tests what is your own and what is from the HRT. 

[Teresa]

Hi Floo,

Thanks for coming back.. I am not in peri but post menopausal. I’ve been taking continuous HRT for past 3 months. My last period was a couple of years ago now.
So the blood test reading of 105 saying I was post menopausal was my reading then? On my blood test results they showed examples of the numbers expected for different categories in our lives and mine corresponded to post menopausal, which it shouldn’t be, on HRT for this length of time. (so therefore it is low ,  as it should be at a higher number)
I haven’t started the higher patches yet….do you think I should?

Thankyou,

Teresa
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[Wrensong]

Hi Teresa, you are right that your oestradiol level is low & indicates that you have not been absorbing very well from your patches.  Whether he feels he should have done or not, it's helpful that your GP arranged the blood test for you.  Hopefully your levels should increase on the 75mcg patch & your symptoms improve further if you feel you want to go up to that dose now.

[Teresa]

Hi Wrensong,
Thankyou, I did wonder. I wonder why he thinks the patches aren’t the same estradiol? I did say they were body identical as well.

I don’t feel right, so I think I will up the patches next time.

Thankyou,

Teresa
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[Wrensong]

I don't know what your GP was thinking Teresa, but there seems to be some confusion.  All I can think is perhaps he had in mind that postmenopause the majority of the oestrogen we produce is in the form of estrone (from our fat cells), but it's estradiol we replace in systemic HRT because that's the more powerful hormone & as Floo36 said this is identical to any little you may still be producing yourself.

It's really good he agreed to test though, as many women struggle to get this approved on the NHS & remain in the dark as to what absorption they're getting which can hinder their progress.

Can I ask what brand of patch were you on at the time of your test - you mention both Evorel & Estradot?  I ask because I get good absorption from Estradot & in the past poor absorption from Evorel products.  To give you an idea, on a 37.5mcg Estradot patch I get levels of 250-270 pmol/L.  I'm long postmenopause, no ovaries.
Wx

[Teresa]

Hi Wrensong,
Thankyou for coming back again…I was on Evorel at the time of the blood test. I was 7 patches through a pack. I had to get Evorel because Estradot was out of stock at my pharmacy 😳 I think they’re back now. My GP has prescribed me 75 mcg if Evorel now. I asked for them as I find them easier to put on, they stick, but not as good as Estradot. The 75s look like they’re bigger than the 50s though from the box size, which I didn’t expect. I have a review with him for my next three month supply in 3 weeks time, so perhaps I’ll go back to the Estradot. I did wonder if it was absorption and after what you’ve said, it makes me think it was 

Thankyou,
Teresa
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[Teresa]

Also…I did use up a box of estradot 50 before the Evorel….I must have been very low mustn’t I?   

Teresa
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[Teresa]

….come to think if it too, as he was reading up on line, he did mention estrone  I remember now….
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[Teresa]

….and he also said to me that he shouldn’t have done the test on the NHS …he was supposed to go by ‘how I feel’ 
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[Wrensong]

Your own estradiol would naturally be low postmenopause.  Mine was below bottom of range @ <44 some years before my ovaries were removed.  And even if you were getting more from Estradot than Evorel I think that would probably have declined quite quickly on stopping Estradot.  We don't know for sure though that Estradot was giving you more & going up to Evorel 75mcg now, you should get more from it than the 50mcg.  Whether enough, only time will tell but if you still have symptoms after a reasonable time on the 75mcg (3 months is usually considered enough to stabilise) I would ask your GP to test again so you know for sure what's going on.  And yes, the 75mcg patches will be bigger I'm afraid  .
Wx

[Teresa]

Thanks Wrensong 
If my symptoms don’t improve a little bit on the 75s, Even just a little bit, I might even ask for oestrogel next time perhaps….that might be an idea.

Thankyou so much for all your help, you’ve explained such a lot and have given me hope 
Teresa
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[Teresa]

…I also think I’d  struggle to get my levels tested again Wrensong  he thinks he was right in what he told me and is convinced I shouldn’t have had the test and that the patches aren’t estradiol  I have no idea how I’d tell him he is wrong 

Teresa
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[Wrensong]

Yes, I was afraid you might have trouble getting retested .  Sadly many women do if their GPs feel their hands are tied by guidelines, which is one reason a lot of us end up going private.  If it's cost to the NHS that's the issue I think it's false economy because the sooner women are sorted on HRT, the less of their GP's time they take up going back for further help.  Potentially too, the fewer other medications they may need.  Imo it does help to know our levels if we still have symptoms. 

As to how to deal with any erm . . . confusion, a lot of tact & creative thinking can be necessary, backed up by documentation from a reliable source! 

I hope you'll feel a lot better on the 75s Teresa.  There is every reason to think they may be just what you need.
Wx

[Teresa]

Thankyou so much Wrensong,
It is hard isn’t it? You are so right about needing to know. I didn’t know I couldn’t get tested on NhS ( and nor did he by the sounds of it  ) it would all help us so much. I am happy that I know what I know now. He’s not a new Gp either, he’s very experienced, but as I continually find out at my surgery, all the GPS lack knowledge of HRT. He hadn’t even heard of body identical HRT.  I had to tell him what I wanted and spell it.

Thankyou for all your help, I really appreciate it.
Teresa
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