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[joziel]

Do we have any kind of idea what serum estrogen should be, for bone protection?

I did some googling of research papers a couple of days ago and got a bit overwhelmed by a massive range of diverse opinions.    There were some researchers wanting to see about 400nmol and there were others happy with 250nmol and still others who felt that as long as you had some, it would maintain your bone density.    Everyone did seem to agree that it was dose dependent, in that the more you have, the more bone you retain - and even lay down new bone at higher doses. But assuming you enter menopause with an acceptable amount and you then maintain that, laying down new bone is perhaps not necessary for everyone(!).

I ended up completely unsure who to believe and what to think about our blood estrogen levels and what is optimal for bone protection. Do we know??

I am interested in this because my estrogen was 233nmol at my last blood test (on 50mcg patch) so mainly for that reason, I increased to 62.5mcg. (I did not have many peri symptoms left.) I am struggling with weird reactions to estrogen (heart palps, episodes of high blood pressure, pulsing or tingling hands and feet - all weirdly usually at night). SO I really don't want to have more estrogen than I need to and I am probably going to manage better on a lower dose. I still had this happening on the 50 patch, but it was less often and less intense.

But if I really need more than 233nmol in my blood for bone protection, I perhaps should remain at 62.5 at least. Can anyone shed any light??

[Pippa52]

I am post menopausal and the Meno consultant said to me that serum estradiol levels for me which also give bone protection should be between 150 and 240.  Bearing in mind I am 69 and I had a  hysterectomy at age 30 and ovaries out at 42 so I have been on HRT a very long time (Oestrogel all through those years at 3 pumps a day  until last year and now on Estradot patches) so it may be that I need less estradiol now.  My bone density scan recently was good apparently.

[joziel]

Thanks, that's interesting Pippa. What level of estrogen are you taking to get to that blood level? (If that makes sense?)

[Floradora]

This is interesting as I too have done huge amounts of research and have read as many papers/studies on this topic as I can. I have just reverted back to low dose Femoston conti after trialling a 50mcg patch for a few months. I decided to increase my estrogen after seeing somewhere that bone protection was ‘dose dependent’ therefore assuming that more would be better. I am at high risk for osteoporosis for various reasons. However, I have ended up struggling with the higher dose of estrogen and have basically felt bloated and jittery and headaches for several weeks now. The deciding factor was that I felt some familiar pains that reminded me of endometriosis and the last thing I want is to reactivate all my old scar tissues/adhesions etc. After 3 days back on Femoston I feel great again so I will just stick with that. I do better on a lower dose and have read many studies showing that low dose (eg 25mcg patch or 1 mg oral) and even ‘ultra-low dose’ of less than that can provide adequate bone protection and not only prevent further loss but can increase density, particularly in combination with calcium/vit D supplements. I’m no good at posting links to things but these are papers by and eminent endocrinologist Canadian I think, called Bruce Ettinger. In my case, more definitely isn’t better and I’m happy to take this low dose forever.

[joziel]

That is very reassuring Floradora. Can I ask how old you are? I don't know if younger women need more estrogen - have you always been on a low dose in the past, before the 50mcg patch I mean?

Is your Femoston the equivalent of a 25mcg patch? And do you know what your blood estrogen levels are? Because in some ways that's more important than whatever amount we are applying, seeing we all absorb it differently.

I've decided I'm definitely not going any higher than my 62.5 and that has taken a lot of pressure off me.

[Floradora]

I’m 54 Joziel however I had an early menopause at 44 so I’m effectively 10 years post menopause. I was on a 50mcg patch for a short while in my late 40s but have been on Femoston conti 1mg for about 6 years now apart from the recent trial with a patch again. My gynecologist was very much of the view that measuring estrogen levels was pointless and that you should simply take the amount of estrogen that was required for individual symptom control. Of course he was also being cautious as he was managing my endometriosis too. He was however very pro HRT and told me to keep on it for as long as I wanted to, possibly for ever.  He also thought that lower doses had been proven to be adequate for bone protection and that if you were having any estrogenic side effects (after a settling in period) then that meant it was too much estrogen for you personally. I feel far better on a lower dose and I’m not prepared to feel bloated and rubbish on the off chance that it might be marginally better for my bones! The effect of taking any estrogen at all versus none makes such a huge difference to bone density anyway that I’m happy to get a good amount of help from a lower dose without having any unpleasant side effects x

[joziel]

Oh thank you so much Floradora that makes me feel so much better. x

[Floradora]

I forgot to answer your question about equivalent doses Joziel. There is some debate about equivalents in the papers I have read but 1mg oral estradiol is generally viewed as equivalent to  a 25mcg-50mcg patch , so a low to medium dose. From my own experience I would say a 25mcg patch feels lower and a 50mcg patch definitely feels higher so an equivalent of somewhere between the two at about 37.5 mcg would seem about right. On this website the tabs showing the different HRT preparations seem to class 1mg oral as ‘low dose’ and 25mcg and 37.5mcg patches are also listed as ‘low dose’ so that seems right. I would definitely suggest taking the dose of estrogen that makes you personally feel as well as possible with minimal/no side effects and don’t worry too much about feeling you should take an increased dose purely for optimal bone protection. You will already be doing a tremendous amount of good for your bones simply by taking any amount of estrogen versus none at all, so I would concentrate on finding a dose that keeps you feeling balanced and happy.

Regarding optimum blood serum estradiol levels, my leaflet for Femoston conti (which is licensed for osteoporosis prevention as well as for menopausal symptoms as not all HRT products are licensed for osteoporosis prevention) states average serum estradiol levels of post menopausal women taking the 1mg version is 35-40 pg/ml which equates to around 150 nmol I think. I assume this means that levels of around this amount are sufficient to maintain adequate bone density . Femoston Conti also do a 0.5 mg version which is not licensed for osteoporosis prevention x

[Pippa52]

Joziel at the moment I am on a 50 Estradot patch plus a quarter of a 25 patch so about 56.5 if that makes sense. If I can stay at this level and keep symptoms at bay that would be great but it's proving really hard to get a dose that takes away the symptoms particularly the anxiety and the palps/tachycardia. Waking up to a bout of it at 150 heart beats a minute at 2, 3 4 or 5am really isn't my idea of fun.  I really don't want to go much higher on dose though if I can avoid it even though I was advised to be on a 75 patch that felt way too much but a 25 was just too low unfortunately. Hope so much you start to level out very soon x

[laszla]

Serum estradio needs to at least 300 for bone protection. This number is stated a few times on Professor Studd's site (hrt pioneer) and from personal experience at Chelsea & Westminster I've been told I need to get to "at least 400" - I'm a non-absorber and with low serum E2 (between 130-250 tops) I've developed osteopenia despite 4 years on hrt. At C&W theyve told me this can be reversed but I need to increase absorption so now I'm on 5 measures estrogel daily.

[joziel]

Thanks lazsla. Darn. It’s all a bit confusing. As I was at 233 on the 50 patch, I hope I’m over 300 at 62.5. I will try to stay longer here. I’m going to explore a low histamine diet and see if that helps.

I worry because I think I’ve had low estrogen for years being on desogestrel- which keeps estrogen from ovaries in the early follicular stage. I’ve not had a bone density scan.

PS I just looked at prof studd s site and he says 300nmol for “an increase” rather than maintaining 🤔 https://www.studd.co.uk/var_bone.php

[joziel]

Pippa were those symptoms going on before you started HRT?

It’s just that those are things I associate with high (for me) estrogen and have only begun since I started HRT.

I just say that because it sounds like you think increasing E is going to help you with them. But to me it would make them worse…?

[Pippa52]

joziel thanks for your reply and I totally get what you are saying. I was however on 3 pumps of Oestrogel which is quite a  high dose for well over 20 years (the equivalent I think of a 75 patch)and that did not cause these issues.  However despite being advised to go on the 75 patch I have not stuck at that dose.  As mentioned I am now on 56.5 and intend to stay at this level for now as  I have a blood test on 12th July and a telephone consult with the Meno consultant on the 20th so am hanging on in there for that.  I have had tachycardia in the past yes but that was due to panic attacks.  Have had a cardiology check out last year and all fine but they have not ever settled down since having the Pfizer jabs plus having to change HRT.  This morning I woke up to more tachycardia and feel really jittery and shaky grrrrr.

[joziel]

Ah right, that makes more sense then. I think high and low estrogen levels can give very similar symptoms which makes things difficult. And then it seems that just changing estrogen levels can also make the body think things have got suddenly high or low maybe (which might be what's happening for me).

I hope things settle down for you too because I agree, it is really awful - I'm starting to suffer from sleep deprivation!!

[Pippa52]

Thanks joziel - yes so agree it is grotty and likewise re sleep deprivation - yuck ....I really need to stick it out on this dose at least till I get the blood results so I know where I'm at re levels. Something isn't right for sure as I still have symptoms so it might be just time and levelling out is needed.  I hope so much things start to improve very soon for you too. xx