Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[laszla]

Hi all, I recently had blood tests showing low Estradiol (around 100), high FSH (also high SHGB). This is despite the fact that I've been on estrogel for 4 years.

My understanding is that if you're on HRT, blood tests are reliable, as pretty much all your estrogen is coming from an external source in a regular dose. So given that my estrogen and FSH are both in the postmenopausal range, I'm concluding that I don't absorb the estrogel at all.

Because if I were absorbing it, even though I am postmenopausal, the plasma levels would be much higher (in the case of the estradiol) and much lower in the case of the FSH.

I need to be as sure of this as possible because I need to find a way out and currently only have uninterested, incompetent GP and a meno clinic who do phone appointments only and the follow-up after the blood test taken at the time of the first appointment is 5 months (I won't be returning).

I either have to get a referal to another clinic or go private as a last resort but for the referal I desperately need to know whether my assumption is correct so that I am sufficiently armoured to go into battle with the GP.
Thanks

[Hurdity]

Hi laszia

Can you just confirm that your blood level is in pmol/l as is usual in UK for NHS blood tests ( not sure about private ones)?

If so then it is pretty low - not exceptionally so, but depending on your estrogel dose (how much to do take?) and your age, you might want to go higher.

My estradiol level on patches was low (just under 100 pmol/l) when it was measured on patch change day and as a result my GP increased my patch dose and it became fine at just under 200 pmol/l pretty much what it had been I think for many years.

Yes FSH is high but I'm not sure at what level of estradiol it would appear depressed. As far as I recall mine has not been measured since being post-menopausal. Personally I wouldn't worry about FSH but if those estradiol levels are consistently low then it is not sufficient to give the best protection against osteoporosis.

If you are feeling generally well on this dose then the osteoporosis argument is your best bet I would say.

Also you could write to Dr Currie - e-maill consultation - costs £30 rather than going private - you should not have to do this! If so do give her the full information eg your age, dose etc

Hope this helps

Hurdity x

[laszla]

Thanks Hurdity, yes numbers are in p/mol. I had been on 2 pumps estrogel since 2018, 10 days utrogestan and a little testogel 3 x weekly, I was 51 at the time and still had periods so have no way of knowing when periods stopped "naturally".

Since I received these results 2 months ago I have, unspervised,  increased my estrogel to 3-3.5 pumps a day as 100pmol is not the number of someone who is on HRT, the consensus seems to be that you need to have at least 200 but better still 300-600.

As for osteoporosis, the blood tests gave me the glad tidings that I'm not far off and am in the highish oseopenia range, additionally alarming for me as I have a low BMI as it is and despite all efforts am not putting on any weight (and I do all the yoga/walking/resistence training caboodle).

After 2 months on the increased dose I don't feel remotely different - and feel very far from well particularly in the chronic fatigue and anxiety department.

What I really need is to monitor the damn bloods and take it from there, either changing E2 delivery to patches, or increase gel to 4 pumps or, in the unlikely event that 3 pumps has increased plasma estrogen, look at other possible causes of current horrible state (have already looked at thyroid, ferritin, Vit D, B etc)

But the GP is extremely unlikely to provide this blood test and has been incredibly unhelpful eg. like a lady in a recent post, GP sent me off for an endo scan, failing to give me the bare-minimum recommendation to schedule right after my bleed -  in my ignorance I booked it right before bleed, eliciting a needless panic with a 2 week cancer referral drama because, quelle surprise, the lining was on the thick side - but then subsided to normality after the bleed.

They also refused to re-prescribe my testogel which the practice partner initially prescribed without a fuss but her replacements won't and never mind that my regime is therefore disrupted on no rational/medical basis, just "we don't prescribe T - I therefore make my own arrangements to procure testogel and my testosterone result in these blood tests was ok in itself but again, because my SBGH is high, it's likely that I'm absorbing very little and the SBGH is also likely to negatively impact absorption of estrodiol - which is low to begin with.

The Chelsea and Westminster clinic they referred me to is also no good because the follow-up time is a preposterous 5 months and I cannot go on unaided; as it is 4 years of my life are down the drain.

I agree that the FSH result in itself isnt a cause for concern - it simply that it's at a level that's in a postmenopausal range which it shouldn't be if I'm on HRT.

Clearly, whacking up my E2 is the priority but I need someone to measure blood again and where appropriate either prescribe a different form of estrogen or increase the gel.

And currently I don't have that someone so am at my wits' end but for my own clarity wanted to be sure that making assessements based on plasma levels (as well of course on symptoms) is valid when on HRT.
Laszla x

[margherita]

I too would like to know whether blood tests are useful as a gauge of how much estrogen we're absorbing. I would have thought - as you mention - that they are reliable if our own bodies have more or less packed it in with estrogen production and our only source is regular estrogel (or similar)...

If you're currently in the lurch with no functioning gp or clinic, perhaps you could have a private blood test in the meantime to see if the increase in estrogel has made any difference to absorption?

[Hurdity]

Hi laszla

I am sorry to hear you seem to be getting less than ideal service from your doctors. Have you had a tests to show you have oseopenia? I didn't realise there were blood tests for this as I thought you had to have scan.

You really have to pursue this with your doc on the basis of the potential osteoporosis alone and considering you are still pretty young. Are you able to contact someone else in the practice? This is a health issue and in my view this is negligent in the sense that if osteopenia has been diagnosed, and your estradiol results are low then increased oestrogen is needed in order to remedy this. It's not like you are 80 or something when bones may be expected to be thinner and you're surely too young to want to take osteoporosis medication when oestrogen would be appropriate.

Other than that as I said before possibly write to Dr Currie for £30 fee.

By the way are you able to post your SHBG and testosterone results? SHBG is normally increased after oral oestrogen but I understand it does not increase (or maybe less so?) with transdermal oestrogen?

I really hope you are able to make some progress with getting this sorted.

Hurdity x

[Helen1968]

I’m so sorry you’re feeling like this. My understanding is that some women just don’t absorb well through the transdermal route and you might be better to try oral oestrogen? My levels were very low, increasing gel has no impact, swapping to tablets sorted it. Might be worth considering?

[VictoryV]

Hi Lazla, sorry you’re going through this nightmare.
Is it ok to drop you a PM?

[Sazzle42115]

Hey might not be any help but my MS says to not worry about bloods as she treats on symptoms however It appears that I am not absorbing estrogen transdermal route. I've been up to 4 pumps of gel and 6 sprays of Lenzetto and still low levels
 She has offered me an implant although I'm a little hesitant she won't prescribe an oral tablet.
Hope you find some relief

[laszla]

Thanks so much for your all your replies.
Hurdity, I agree it is negligent. I have lost all faith in this surgery but I know I've somehow got to move forward so I called them today and if I don't want to see GP who triggered cancer scare by not telling me about right timing for scan, I would have to wait 5 weeks (versus 4 weeks), and that's just for a phone appointment (with an unknown GP).

My testosterone was 1.2 and SHBG 138.

I did an email consult with Dr Currie and while her suggestion to try a different type of estrogen makes sense, I am still going to need someone to prescribe it.
At the moment I'm thinking maybe of getting a private blood test if I can find one to see if increase in estrogel dose has raised my E2, it might be a starting point and it would feel as if I were at least moving forward while I decide whether I can tough it out with this GP practice or not (am increasingly inclined to think not).

Helen, I would consider oral estrogen though would first prefer to try patches if gel increase doesn't work, glad the swap worked for you.
VictoriaV, yes of course, thanks
Sazzle - I hadn't thought about implants, might be worth investigating when I get to see someone. I know many work with symptoms alone but I really feel the need to know what my plasma levels of E2 are because of the osteopenia.