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[Marchlove]

Ah, that’s confirmed it for me then regarding the contamination with blood spot, even with gloves on!
Yes the Dutch test is brilliant x

[laszla]

Read this thread with interest! I have found testing of my Estrogen to be absolutely critical in my meno journey as an indicator of where things are. I've always used venous tests from Medi checks and found the results to be very reliable. Never been convinced of the notion of your Estrogen level fluctuating massively during the day - doesn't fit with all the publications of how your hormones fluctuate regularly in a cycle and certainly hasn't been the case for me. I often wonder if that's a myth peddled by the NHS who don't want to do blood tests! You do have to test on roughly the same day in a cycle if you're still having one, in order to get a good comparison, but doing it that way has worked very well and very reliably for me.

I completely agree with this and have also found blood testing to be crucial for my HRT odyssey. No doubt in peri there is fluctuation but once our own hormones have pretty much packed it in and we're solely reliant on HRT for hormone intake, then in fact our intake and levels are likely to be pretty stable. I've been told not to take HRT for 24 hrs before testing and of course to test venously to avoid contamination and with those precautions have found blood levels reliable and stable (albeit reliably bad/low in my case!)
I am now seeing Panay on the NHS and he too is absolutely using and encouraging serum levels of hormones as a guide to what's going on hormonally - while also of course listening to what symptoms are.

[Hurdity]

Re discussion abut saliva tests and blood tests. This is a perennial issue (raised by some who use the private system for their healthcare, saliva tests being used notably by some practitioners not recommended by BMS).

Here is the lowdown:

It is well established that saliva testing is an inaccurate way of measuring sex hormone levels and not recommended by the menopause societies eg North American Menopause Society:

“Testing hormone levels is not required to determine whether a woman has the “right amount” of hormones. The optimal hormone levels in postmenopausal women have not been established. How symptoms respond to a particular dose of hormones or nonhormonal menopause medication is the only reliable guide.

Saliva testing is often a part of custom-compounded “bioidentical hormone therapy” with hormones. But saliva testing is not only unnecessary; it has also has also not been proven to be accurate or reliable. Because hormone levels vary day to day as well as throughout the day, even a blood test cannot accurately reflect the body’s hormone levels.

The common hormone test that may be appropriate is for the level of follicle-stimulating hormone (FSH) to help determine if a woman is in menopause, especially for women who do not have a uterus and thus cannot tell by their menstrual pattern that they are menopausal.

NAMS does not recommend saliva testing to determine hormone levels and does not recommend custom-compounded products over well-tested, government-approved products for the majority of women.”

https://www.menopause.org/publications/clinical-practice-materials/bioidentical-hormone-therapy/what-is-hormone-testing-

British Menopause Society

https://thebms.org.uk/publications/consensus-statements/bioidentical-hrt/

Hormone level testing

"Some HCPs who prescribe cBHRT claim to be able to determine the precise requirements of each individual woman through a series of complex serum and saliva tests. This costly practice has never been substantiated through rigorous research, it is not recommended by the menopause societies and it is largely unnecessary."

Two of the Key messages:

"There is insufficient evidence to justify multiple serum and saliva hormone tests often claimed to precisely individualise cBHRT

The management of women with menopause related problems should be underpinned by the principles and guidelines of the British Menopause Society and wherever possible, regulated products should be prescribed"

Hurdity x

[Hurdity]

Gilla99 - good that you are having appropriate treatment and that in your case you are finding blood tests to be helpful and I ohpe you continue to feel well.

However - I do take issue with this comment:

"Never been convinced of the notion of your Estrogen level fluctuating massively during the day - doesn't fit with all the publications of how your hormones fluctuate regularly in a cycle and certainly hasn't been the case for me. I often wonder if that's a myth peddled by the NHS who don't want to do blood tests! "

Circadian rhythms are a well established biological phenomenon and undisputable - different biological systems exhibit them in various ways.

Re estradiol -  I haven't done an extensive search but here is the first one I came across (I haven't read the whole article which is probably not relevant to the discussion):

"Estradiol demonstrates a circadian rhythm. The diurnal cycle of estradiol exhibits an early morning peak and two, three or four ultradian harmonics throughout the 24-hour period [25]. During the menstrual phase, the peak in estradiol occurs later in the morning. The normal character of the estradiol rhythm is relatively unaffected by the menstrual cycle, except for the acrophase during the menstrual phase."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5853846/

As for the NHS - why on earth? But I expect it was tongue in cheek! The need for blood testing of hormones and when it should be carried out was set out in the NICE Guidelines on menopause and were based on extensive literature review....that in most cases blood testing is not necessasry - at least to diagnose menopause. I can't remember what they say re ongoing testing....

And of course also financial considerations must be taken into account - as well as the science. There are many cases where we would like the NHS to do more eg regular endometrial scanning for women on HRT to enable greater individualisation of HRT, if only funds were available...

All the best

Hurdity x

[Blue Kingfisher]

Thank you Hurdity, extremely interesting.

I think the key answer for me in starting this thread is symptoms, symptoms, symptoms. I had two tests, one saliva, one serum blood. Saliva says I’m far too high in oestrogen, blood says I’m 105 and need more. I decide to reduce the oestrogen, I feel terrible (insomnia, night sweats, etc). Ive subsequently increased the oestrogen - flushing, night sweats, insomnia improving massively and swiftly. I will only use bloods as a guide going forwards but be ruled by symptoms. May be different for other people but I’m learning the hard way, what works for me!

[CLKD]

Which ever route 1 takes to determine levels, 1 has to be aware of those Companies who sell products on the back of their 'results'.  Cynic, Moi?   

Symptoms can be charted successfully by keeping a diary.  Fortunately I never suffered badly in peri., though I do wonder if the depression and anxiety problems did increase in those years; I can't remember how my cycles were then to be retrospective - appropriate medication has helped.  VA symptoms have been eased by 'ovestin'.  Itchy skin treated with hand cream.

It's the Trial and Error that can be so tiring.  As well as wanting to be well sooner rather than later.  Because many are dealing with young children/teens/aging parents which is difficult enough, without throwing hormonal upheaval into the mix!

[Gilla999]

I totally agree CLKD, it is a bit of a minefield knowing who/what to trust. And also if there's one thing I've learnt through this forum and my peers it's that one person's journey doesn't match another, so what is helpful for someone (eg me with my blood tests) is not necessarily helpful to another.

The trial and error makes everything so long and drawn out and I am guilty more than most of wanting to just "fix it" immediately. I have to remind myself to think about how far I've come in the last year and just keep putting one foot in front of the other!

[Gilla999]

Sorry Hurdity missed your post!

I can only give feedback on my own experience which is that the blood tests I have every month are stable relative to where I'm at in my cycle, regardless of what time of day I have the test (i always test on day 21). I'm talking about to within 100pmol, not within 2 or 3!

Yes tongue in cheek but also born out of my frustration at the treatment I've received from my doctors during my Peri journey. Knowing my estrogen level has been absolutely key and critical to me and i've found it frustrating that GPs refused to test it. FSH only tells you if you're ovulating and for a proportion of women the symptoms of Peri start before your periods go haywire, something which isn't talked about enough or understood by many GPs. Coincidentally knowing my estrogen level prior to Peri and then testing it again when I was highly symptomatic enabled me to really see that it fallen dramatically and understand what was happening. Continuing to monitor it has been equally as valuable for me.

I think the key point I was (not very eloquently) trying to get across is that different strategies work for different women, as everyone is so unique - tests might be crucial to me and not for someone else and vice versa xx