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[Teresa]

Hi All,
I hope someone might be able to help.
I’m post menopausal and on a continuous regime of Evorel 75 and oral utrogestan with a recent history of breakthrough bleeding after being on this dose for well over a year. I also have fibroids. After a recent hysteroscopy, the gynaecologist told me to increase the utrogestan to 200 mg orally a day, due to me being in a 75 mcg patch, despite me having a thin lining.

I’ve been taking that now for about 6 weeks and I don’t feel it’s right for me at all.  I feel very lethargic and more anxious than I was. Other small things are noticeable like my skin, which is dry, has become drier.

The gynaecologist didn’t realise that the only reason I’m on the 75 mcg patch is that I don’t absorb Estrogen very well and with the 50 mcg patch, my estradiol levels were only 106 pmo/l after 4 months of HRT. I‘ve never had a retest since then, but I have my suspicions they’re still not much higher, even on the 75.

I’m intending to ask my GP this afternoon, if I can be retested for my estradiol levels and I wanted to try and gauge from others what level they should be, either on a 50 or a 75. I know we are all different, but I’m hoping there is some average level I should be at? If it is still low, I’m thinking of asking if I can try eostrogel in the hope I might absorb that better.

Thankyou in advance,
Teresa
X

[CLKD]

Ask for a referral to a dedicated menopause clinic as Gynaes and GPs often don't have enough knowledge about HRT. 

[sheila99]

I think the fibroid is the problem not your levels. You were good on 75 patch and 100mg utro, lining was thin so the only problem was the bleeding and we know fibroids can cause it. As the lining was already thin taking more utro is unlikely to help and may make it worse as the lining may become too thin. Gynae should know it isn't important how much you put on your skin, what's important is how much you absorb and that seems to be not much. It's possible you'll absorb gel better but it's still transdermal so no reason to expect you will. If it was me I'd stick to the original regime and see if they'll remove the fibroids. As you say we're all different so the right dose for you is the lowest that controls your symptoms. Blood level is an indication but not the most important factor (and may be very different from what I need to feel good on).

[Teresa]

Hi CLKD & Sheila,

Thankyou both for your replies. I’m back now from the GP and after reading what the gynaecologist has suggested and me telling him I’m feeling bad on the 200mg he to agreed that I shouldn’t be taking it and doesn’t understand why she suggested it, as my lining is already thin. So as of tonight, I’m back on the 100. But he doesn’t know what to suggest going forward and Sheila, yes, you’re probably right, it’s the fibroids causing the bleeding - though nobody has actually said that, but I do wonder as well. CLKD yes, I know you’re right about GPs and Gynaecologists and HRT as he admitted he didn’t have a clue. What he suggested was I see someone privately. He was going to refer me to the NHS menopause clinic, but there is a year waiting list.

He said that once they prescribe something else and it works, to let him know.
They won’t remove my fibroids unfortunately. I’ve got a few, but it was never suggested. I think the biggest is about 6mm, so not that big.  When I have a bleed,it’s gone on for two weeks each time and is actually quite ‘clotty’ so I do wonder if I’m actually shedding lining. It’s a difficult one.

I’ve got a blood test form to check my estradiol levels and a few other things, I just wanted to know for myself really as I don’t think my estregen levels are that good and never have been. I’ve just got ‘used’ to feeling like I do, I think.  I just wanted to gauge the sort of levels others had, who were of similar dose etc out of curiosity really.

Thankyou
X

[laszla]

As others have said, individual feel-good levels of E2 vary - I need around 600 pmol myself (and it took me literally years to reach that level) - but several sources indicate that at least 300 pmol is desirable for bone protection.
Shifting to oestrogel might well help, I absorbed nothing on patches and did better on oestrogel.
It's good that you're getting your levels tested, personally I found regular testing helpful though many people go on symptoms alone, I think both are important.

I also am convinced that the total oestradiol level that's measured in the blood test does not give the full picture in terms of useful absorption. For instance with testosterone, the 'free' testosterone is calculated to gauge how much is bioavailable rather than bound with SHBG (free androgen index).
But oestradiol also binds to SHBG yet 'free' oestradiol is not measured. I have a very high SHBG so am sceptical about how much of the hormone is available to make me feel better.

So if you can I would try to get the SHBG tested, and possibly testosterone.

[Floo36]

I found that because I wasn’t absorbing the Estrogen the utrogestan was making me bleed and over thinning the lining.  They only seem to go on about Estrogen causing problems but progesterone can also if the ratio isn’t right.

[Teresa]

Hi Laszla,

Thankyou for coming back and being so helpful. To be honest, I’m not really sure how I’m meant to feel anymore and if it’s right. I don’t think I’ve ever really felt ‘good’ in the past two or three years since I’ve been post menopausal and since I’ve been in HRT. I still have bad anxiety. The only thing I would say it has improved, are no hot sweats and that’s about it.

Sadly it’s too late to change my blood test form as my GP has already done it - it’s just estradiol that he’s asked for, which is what I had last time. It was maintaining bone health that I was particularly interested in and one of the reasons I went on HRT and I never knew that around 300 was the figure for that., Thankyou. As I mentioned, my last reading when I was on the 50 patch was 106, so if I can get to this figure at some point, I’d be happier. I have a feeling I’m nowhere near that. As my GP knows nothing about HRT, he wouldn’t have thought of those other tests sadly 

I’m hopefully going to get a private appointment in the next few weeks so perhaps they will test more…I hope they do. Your reply has given me a lot to think about.

Thankyou,
Teresa

[Teresa]

Hi Floo36,

Thankyou for coming back. Your reply was certainly very interesting as it sounds like what happened to you, is happening to me 

If this is the case, I can’t imagine why the gynaecologist asked me to double my utrogestan  I just cannot fathom it out and nor could my GP.
Please can I ask what you did to sort out your bleeding problem?

Thankyou,
Teresa