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[RebJT]

Hi Ladies

Not for the first time am I frustrated that it appears beyond the wit of medicine to come up with a simple fact sheet for these obvious and repeated questions, but there we are ... I digress.

Can anyone help me work this out please? 

I've been on HRT since 2019, my history is a bit complicated but lately there's a question whether I'm absorbing oestrogel.

Last month, on day 9, I had a venous E2 test - on the advice of my gynae I was off gel for 24 hours, and blood was drawn from my arm where I'd not applied gel for over a month (I was on 3 pumps) and the result was 157.  (the previous month I'd tested but didn't know you weren't supposed to apply gel, and defo not to the arm, and the result was 600 which would suggest a corrupted and invalid test- why does nobody tell you this???)

On the advice of the doc, went up to 4 pumps for the next month.  Still not applying gel to the left arm, just the right and my inner thighs.  This month I tested again on day 9, but applied 4 pumps of gel to my thighs 2 hours pre test.  Result was 212.

Is this the right way to test absorption?  If yes, I'd say I'm not absorbing? 

I'm slightly confused given E has a pretty short half life, why the logic seems to be test off gel (I also have thyroid issues, and thyroid has a half life of 9 days, and peaks just after you take it so I get why you test before you take your meds, not so sure about E).

Seondly if I'm not absorbing, what do I do now?  Are patches generally better, and if they are how do you transition?  I mean I assume if I'm not absorbing 4 pumps of gel, you don't just immediately slap on a 100 patch as it might be too much?

I've had that fluey virus that's going around, so perhaps that's muddied the waters but I've had an outbreak of night sweats, itching and vag soreness - back on loading doses of vagifem and ovestin that's making it better - so I'd say that indicates my E is now in my boots.

Also to say my gynae wants my levels at 600+.

Thanks.

Reb
x
Edited for typo

[Pippa52]

Its so confusing isn't it.  I was tested when I was on Oestrogel 4 months ago and my result was unbelievably low at 53 pmol .  The Meno consultant said to me I might as well not be on HRT at all as I was not absorbing any of the gel.  I was swopped onto patches (estradot) which I have under advice been slowly increasing.  It went up to 143 pmol after 2 months on a 50 patch  and the latest test last week was 163 so I am on the right track.  I am now on a 50 patch plus half a 25 patch so on about 62.  I think this is seeming to be the right dose for me as I was up to over 70 at sone point as the Meno consultant suggested I aim for a 75 patch but that was just too much for me.  It is such an individual thing finding the right type of HRT and the right dose and it really does take quite a while to get it right.  For me symptom control is what I am aiming for at the lowest dose and it seems (so far) for me personally that is around 62.  I definitely am absorbing the patches better than I did the gel though.  I hope so much you will get to the right level for you soon x

[discogirl]

Its so confusing isn't it.  I was tested when I was on Oestrogel 4 months ago and my result was unbelievably low at 53 pmol .  The Meno consultant said to me I might as well not be on HRT at all as I was not absorbing any of the gel.  I was swopped onto patches (estradot) which I have under advice been slowly increasing.  It went up to 143 pmol after 2 months on a 50 patch  and the latest test last week was 163 so I am on the right track.  I am now on a 50 patch plus half a 25 patch so on about 62.  I think this is seeming to be the right dose for me as I was up to over 70 at sone point as the Meno consultant suggested I aim for a 75 patch but that was just too much for me.  It is such an individual thing finding the right type of HRT and the right dose and it really does take quite a while to get it right.  For me symptom control is what I am aiming for at the lowest dose and it seems (so far) for me personally that is around 62.  I definitely am absorbing the patches better than I did the gel though.  I hope so much you will get to the right level for you soon x

hi pippa52

sorry to cut in.

im so glad your absorbing the patches.
 
which patches are you on xxx

[Pippa52]

disco girl I am on Estradot patches.  How are you doing?

[laszla]

Hi Reb,
I test regularly and was advised not to apply any oestrogel on the day of testing (venously); on the other hand no one has ever advised me not to draw blood from an arm that normally has the gel applied, that seems quite extreme.
As for patches being better or not than gel, for some yes and others no.
I am a chronic low absorber and when I switched to 100 patches (from 4 pumps gel) my serum levels of E2 plummeted.

As a result I'm going to try an implant later this year when I get my intermittent bleeding under control - which is simply the result of going onto conti utrogestan but the hospital want me bleed free before applying the implant. They start you on a 50mcg implant which is a bit scary when one's been on a much higher dose of gel but I suppose in theory a well absorbed 50 might be more productive than 100 or more that's going nowhere.
I too have been advised to get to serum levels of 600-800.

[discogirl]

disco girl I am on Estradot patches.  How are you doing?

ok i think.

still no pattern with my sleeping but hey ho.

im glad your feeling better on the patches.

i had my bloods done a couple of wks ago and they were 288. i did apply my gel that morning but didnt have my bloods done until 12noon so i was fairly pleased with that xxx

[RebJT]

Hi both

Thanks for replies, it's really confusing isn't.  I was even told not to use the hand from the arm of the blood draw.  So I guess the idea being 24 hours off measures your steady baseline levels rather than the peak after application?  Either way that doesn't bode well me, up a pump and still only just over 200, and now on the max licensed dose.  Confess I went up to five pumps today, and back to applying to arms and shoulders not thighs and feel like a new woman already, plus no soreness, but still got a heat rash and some itching, it's bloody rubbish.

My sis in law is a chronic low absorber, post total hyst she was put on two pumps and left to rot, she's now under Mr Pannay and on 2 x 100 patches and gel and she's up to 700 and finally back in the land of the living - her GP is lived, but hey it's Mr Pannay so what's he gonna do but shout (which he does, frequently!).  I don't know why I'm suddenly symptomatic, but maybe my own levels have dropped and the bit I'm absorbing isn't enough to keep me going.

Awaiting email back from the gynae, as clearly need some guidance on patches but yes another lady I know who saw Prof Studd for years after a hyst in her early thirties was on implants (for E and T) and did brilliantly, but it's the having to wait and see on new product and or dose that's miserable as it's really derailing my life now.  But yes I suppose if 4 pumps isn't absorbing and I just switch to 100 patch, I might blow my head off, if it suddenly does absorb.

Anyway, thanks, I just wish the BMS or whoever could come up with some factsheets - the forums are full of miserable and worried women asking the same questions over and over again, how difficult can it be?

Anyway, thanks

Reb
x

[Bungo]

Surely Louise Newson has some guidance on this? I meant to sign up for a month to Balance+ to watch her webinar on absorbtion but forgot to

[RebJT]

I don't know, not that I've seen.  My gynae (amongst others) calls her 'that woman' and I know some of her advice is off (histamine intolerance fact sheet is inaccurate), so I'm slightly sceptical I must say.  She's done a lot for awareness raising, heard plenty of horror stories from her clinic.  One lady I chatted to paid £250 for a ten minute consult and when I pointed out they were only GPs and why was she paying consultant gynae prices she was shocked.  She said 'they're the best experts in the country' - nope, they're GPs who've all done her training, that's it.  It's clearly a very profitable business, not sure about the rest ...

[Bungo]

I can't find now but I came across an academic paper that was saying exactly what you are.  That there are no guidelines on application prior to blood tests. How much of an area to apply gel for optimal results etc. s

[Kathleen]

Hello ladies.

I have had several blood tests through Newson Health and each time I was told to abstain from the gel on the day of the test and if I used some gel the night before I had to miss that one as well. I also had to refrain from using Testosterone (Androfeme) on the day of the test. In all honesty I didn't find the test results very helpful because I could not associate them with my symptoms. For example at one point my Oestrogen level was 600pmol/L but I was still having mood swings etc. My doctor at Newson Health said that I should have been feeling great at that point and although I felt good for a day or part of a day there didn't seem to be any consistency or progress. Shortly after this high reading I developed painful breasts and bleeding so I was definitely absorbing the gel, perhaps too much but that possibly was never mentioned.

I am one of those people who has become disillusioned with Newson Health and meno treatment generally.  The NH doctors I saw were all reading from the same script and were at a loss when their treatment didn't have the expected results. My idea of a specialist or expert is someone who has some expertise and a range of experience. One NH doctor said there was no point in me asking other questions because 'she only did the hormones'. At my last appointment a different doctor wondered if my mood problems were caused by something other than low oestrogen, I expected her to have a few suggestions which I could pursue with my own GP but she didn't say anything further.

I have since been following the advice of an NHS Consultant and although this regime is helping in a small way I still have major emotional symptoms. I have an appointment at his clinic next month and I hope something positive comes from that.

Sorry to be such a moan ladies but the above experiences have at least made me consider that factors other than the menopause may be contributing and I am awaiting some blood test results from my GP.

Wishing you all well ladies and take care.

K.

[RebJT]

Hi

Thanks, yes you'd think they'd have worked out how to bloomin' test absorption by now wouldn't you?!  That's interesting about the academic paper.  I'll save my rant about women's care generally for another day, but if you look at the time, money and research that's gone into viagra comapred with women, then that tells you quite a lot.

I know NH send their messes to my gynae to sort out (in a particular niche area) - they seem good if gel and utro sorts you out, but outside the mainstream, with tricky issues, not so much, and they are definitely overpriced, I pay £250 for an hour with a gynae in a Harley St clinic, I wouldn't pay that much for a GP.

And yes I know tests aren't the be all and end all, I just want to know if I'm absorbing it.  I had a nasty virus and had sudden onset v low E symptoms - vag soreness, night sweats, bone crushing fatigue, black mood, and all over itching, blood test seems to bear this out.  I'm still having cycles so my own cycle is obviously sputtering along in the background not helping matters.

This area of medicine should be a priority - we are in the prime of our lives, at peak earning capacity, running businesses, homes, caring for elderly relatives bringing up kids - the world would grind to a bloody halt without us, and yet we don't seem to be a priority, p*sses me right off!

Reb
x

[RebJT]

PS Kathleen

I've heard many stories like yours re NH and the 'should be feeling great' - they don't seem to know what to do or what to look for if you don't, I agree.  Sorry you went through that, it's not good enough really.  Lots of gynaes are like that, but there are some fab gynaes also, who will get in the trenches, hold your hand, and help you work it out. 

Hope you find some answers.