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[Bupster]

Hi everyone,

Second post in a week - sorry, I'm just at a bit of a loss. I have been on HRT for a year and gradually built up to four (and occasionally five) pumps of oestrogel which was keeping me steady. A couple of weeks ago I started feeling rubbish, brain fog in the afternoons and waking up very early. I went up in dosage quite rapidly to six and immediately felt better, but was a good girl and told my GP. He's asked me to bring it down to four doses, and I'm due to get blood tests in about three weeks, so I'm trying to taper back down first to 5, then to 4. However, I'm feeling appalling. I've had an incredibly painful two week period, starting from when I went up, accompanied by crippling stomach cramps; the brain fog comes down every day a bit earlier; and I'm waking up early and full of anxiety. Essentially, in the last three weeks I've had three days of feeling okay - when I first raised my dose. However, I'm now starting to second guess myself; is it possible that it's the initial high dose that's causing all this?

One reason I'd really like your advice is that I want to try to taper down before my bloods are taken but afterwards I am very tempted to go to the Newson clinic as I know my GP is unlikely to prescribe the amount I think I need. But what if I'm wrong?

All advice truly welcome. I feel atrocious and I don't know if I'm making myself better or worse or how I'm going to manage the next few weeks and beyond.

Thank you,
Bupster 

[CLKD]

No one should feel ill.  If your oestrogen levels have dropped and the additional HRT helps, then your GP needs to listen.

Which regimes are you using? 

[Bupster]

Thank you for replying! I'm on Oestrogel, and the manufacturer's maximum recommended dose is four. A friend of mine who's a GP says that means the NHS are really unlikely to prescribe any more than that.

I also want to make sure that, when it comes to the blood test, it's measuring my 'official' levels of oestrogen, not an artificially inflated one because I'm slapping Oestrogel like a mud mask 

My problem is that I don't know for certain that my oestrogen levels *are* low. That's what I thought, but the two-week period suggests low progesterone, and the symptoms of high oestrogen seem to be the same as low  . So I'm at a bit of a loss, and just desperate to start feeling normal again.

[Dotty]

Hi blood tests won’t tell you anything as there is no magic number for oestrogen levels. If you need six pumps to feel well then that’s the amount you need. Have a look at this article by Dr Newson…

https://www.newsonhealth.co.uk/why-are-some-patients-prescribed-higher-doses-of-oestrogen-than-others/

[Ermin2trude]

Hi Bupster,

The ideal ration of oestrogen:progesterone when we were younger is 1:2. That’s the optimum our bodies operate normally at. So if you are using 4 pumps of gel (equivalent of a 100mg patch) you will need 200mg of utrogestan or other progesterone. This would be perfect if our own hormones didn’t get in the way and fluctuate in the background, and our absorption rates of HRT didn’t differ. What dose of utrogestan are you on? Is it continuous?

Oestrogen is the bleeding hormone, so if your oestrogen is more than half of the progesterone, you will have a bleed and might feel other side effects too (as you are reporting).

I’m a patient with Newson Health. I highly recommend them if you are struggling to get dosage right.

[Hurdity]

Hi there - Ermin2rude - it doesn't really work like that. it's not possible to compare delivery methods and does of oestrogen and progestogens in a simple way.

Bupster can you say what your periods were doing in the months leading up to your starting HRT and how old you are? Your natural cycle may be strong or as you say you may not be absorbing the oestrogen. If you are peri-menopausal and using gel then blood tests, as Dotty says, won't really tell you anything.

What were the symptoms you were looking for HRT to alleviate and have these improved?

Maybe you would be better off with a different method eg a patch or Lenzetto spray? If you are younger maybe one of the contraceptive pills that contain estradiol that suppress the cycle, if it is the cyclical issues that are bothering you, though high doses of oestrogen should cushion the effect of cyclical oestrogen crashes, to some extent.

You haven't said what progesterone you are taking alongside the oestrogen? This is key to preventing a heavy bleed. The higher the oestrogen dose, the more progesterone you need to protect the womb, though if you are ovulating you will be producing your own too.

There are treatments for heavy bleeding and if you're concerned, also mention to your doc.

Sorry to hear you're not feeling too good and hope you are able to work out a regime to enable you to feel better during this difficult period of time.

Hurdity x

[Kathleen]

Hello Bupster and welcome to the forum.

I am a patient of Newson Health but due to investigations for bleeding I have also had appointments with an NHS consultant. The NHS are concerned about the high Oestrogen doses prescribed by private clinics which don't conform to the guidelines.

I have been with NH for three years and they prescribed increasingly higher doses of gel and lower doses of progesterone with testosterone thrown into the mix.  I understand this regime works well for some but it was all too much for me and I had breast pain and heavy bleeding when using the equivalent of six pumps of gel. Consequently  I was forced to lower my dose of gel and I now use the equivalent of two pumps daily. The side effects settled down but unfortunately some Meno symptoms are persisting, namely anxiety, low mood and tearfulness.

Obviously I want to address these issues and I will raise them at my next NH appointment. I will of course update the forum for anyone who is interested.

NH were keen to measure my oestrogen levels and were pleased that my numbers reached the 600s however although I felt better some of the time I was still having episodes of anxiety and low mood etc even at that level. I suspect NH would have advised me to go even higher but the bleeding meant I had no choice but to reduce my HRT.

Having said all that I think NH are worth trying as they will have more options available than your GP.

Take care.

K.

[Ermin2trude]

Hi there - Ermin2rude - it doesn't really work like that. it's not possible to compare delivery methods and does of oestrogen and progestogens in a simple way.

Hi Hurdity,

I didn’t say it was possible to compare. If you read it carefully you will see that I said what the perfect ratio is, but unfortunately our own hormones etc don’t play ball.

[Furyan]

I’ve recently been wondering whether my oestrogen is too much or too little too. However, I figured that my oestrogen is fine though (only on 50 patch) as I have good enough symptom control on that. I could have been fooled into thinking it’s too much as I have very sore boobs, fatigue and a bit weak: I concluded that more progesterone is needed to balance it out so I experimented with taking more progesterone yesterday and today. Lo behold, my sore boobs starting to ease slightly, not so breathless either. Time will tell but I hope that by adjusting the progesterone rather than oestrogen, it’s going to provide the balance I need.