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[RosieRay]

I posted recently about being perimenopausal for the last 7/8 years.

I am on Estradot 100 and 100 Utrogestan daily. I have a period every 14-22 days much to my eternal frustration. I recently have had a return of hot flushes, exhaustion and general low mood and so asked to increase my oestrogen patch. My doctor reluctantly agreed to go up to 125 estradot patches.

Before the increase they did a test of my estradiol on day 13 of my 22 day cycle, so likely around ovulation. It was 250 pmol. My last reading in December 2022 was 785 pmol at about the same time.

It 250 pmol a low reading? I'm googling but getting various answers!

[Nas]

If you are peri menopausal, you should be taking the utrogestan sequentially each month  i think. This could be why you are bleeding? Continuous is for post meno women ( no period for 12 months +)

Figures don’t mean much, but symptoms do. Chances are you are not absorbing the oestrogen from the patch? What do you think? Maybe a change of regime would work better?

[RosieRay]

If you are peri menopausal, you should be taking the utrogestan sequentially each month  i think. This could be why you are bleeding? Continuous is for post meno women ( no period for 12 months +)

Figures don’t mean much, but symptoms do. Chances are you are not absorbing the oestrogen from the patch? What do you think? Maybe a change of regime would work better?

Hi Nas - I have to take it continuously because otherwise I get horrendous migraines and due to my short cycles I end up not taking it regularly enough for uterine protection. I have fiddled around with a few things but my instinct was that my oestrogen was too low. I just can't work out what the levels actually mean!

[joziel]

So you own body will be contributing varying amounts of estrogen during peri. That is why it might have been 700ish once. But a low reading is a good indication of what you are actually getting from your HRT. 250 isn't a high reading and is a tad too low to be optimal in terms of bone health, where you want 400-600 for most women (according to my Newson doctor).

You might not be absorbing patches very well. This happened to me with patches too. I had to switch to gel, which I'm doing much better on.

[Hurdity]

Rosieray - As already said, estradiol levels will vary according to your cycle and although you say it is the same point in the cycle, if you are perimenopausal then it is most unlikely to be at the same point because peri-menopause is defined by irregular cycles! I mean if a cycle is regularly every 22 days (without HRT) then this is not peri-menopause but the last stage before. Also levels will vary according to time since patch change, and possibly also with time of day due to circadian rhythms, and also skin temperature which will affect absorption.

It may well be also that the dose of utrogestan is insufficient hence the frequent bleeding ( as well as your own cycle coming into play). I agree that the return of flushes usually indicates insufficient oestrogen, having ruled out other causes. As joziel says also you may not be absorbing well. Have you tried gel or spray?

250 isn't a high reading and is a tad too low to be optimal in terms of bone health, where you want 400-600 for most women (according to my Newson doctor).

I'm curious as to where this very high figure comes from - I have not read anywhere that these levels per se were optimal for bone health, though I'm not up to date. The dosages licensed for osteoporosis protection are only medium doses and I doubt would consistently give levels this high. In my case, (only one example!) my levels on HRT have been around the 200 mark I think most of the time though since I increased my patch slightly they haven't been measured but I doubt much more though - but as I understand my bone health is good (haven't had a proper bone scane though) - even at my advanced age (70), I have not lost any height.

Hurdity x