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[joziel]

How long after increasing a dose is a blood test an accurate reflection of that increase?

For eg: I went from 3 pumps to 4 pumps. 8 days later, I had bloods done which showed estrogen of 283pmol. Is that a reflection of 4 pumps for me, after 8 days on it?

(NB I wasn't having the test to check estrogen, it was to check testosterone levels - but my GP threw estrogen in there as well, which I didn't know about until I got the result.) I know that 1 week isn't enough to know the results in terms of symptoms, but in terms of increasing serum estrogen levels, it should reflect that 8 days later right?

If I'm only on 283pmol with 4 pumps of gel, I'm thinking I'm a poor absorber? Unfortunately things seem the same with patches so I might end up with a million tonnes of estrogen applied to my skin at this rate... I still have some nighttime symptoms.

[Bungo]

Sorry no help to you,.just chipping in as have similar issue and hoping someone knows the answer. Did you test oestrodial levels 24 hours after applying?  I had gotten bloods tested 24 hours after applying gel and showed values between 159 and 179. GP said that's grand as it will rise after apply gel. Out of curiosity, a few weeks ago,  I got tested 7 hours after applying gel ( I made sure to put gel on thighs so wouldn't contaminate the blood sample). Oestrodial that day was only 80 so the previous results.must have been my own natural oestrodial levels and I'm not absorbing the gel at all it seems. I'm mainly on it for bone health ,last period was Jan this year. Going by symptoms isn't any help for bone health so frustrated by the last of knowledge and guidance etc on absorbtion.
Your levels of 283 do seem low after 4 pumps. Have you ever tried patches or a different method. I heard some expert say that if not absorbing, you're best to try a different method rather than increasing the pumps etc. I'm loath to switch for now so will wait until a full year after periods to retest AFTER applying gel and see what levels are

[joziel]

Hi....

Well, because I didn't know I was being tested for estrogen(!), I didn't do anything differently that morning. I put my gel on as usual and went to the GP. My appointment was in the morning, so I probably had the gel on maybe 1 hour before the appointment....

I always apply gel to thighs - 2 pumps to each thigh - so no chance of contamination.

Annoyingly yes, I did try patches - I started out on patches. On a 75 patch I was only at 198, so it was deemed that I wasn't absorbing very well and I was moved to gel. This is the first test I've had on gel. I've been on it since about July.

[Bungo]

I read some paper ages ago that said that oestrodial reading 12 hours after application of gel would give you the average over the 24 hours. So maybe,  if you took bloods 5 or 6 hours after applying, the levels would be higher. If having symptoms, then apparently can be caused by too much of too little oestrogen . It's so annoying isn't it that it's complicated. I'd be very happy with levels of 283 for my bones but for symptom relief, should  you be increasing or decreasing.  Are you post menopause? I can't wait for that so at least will know it's the hrt giving whatever reading I get

[joziel]

It might make some difference to have tested at peak absorption time - but really I don't think levels can fluctuate that much with gel through the day or they'd be telling us all to use it twice daily for stability and to spread the dose out. I know it's said to be not quite as consistent as patches but don't think it's going to vary by too much...

Not post-menopause, no. But whilst my own ovaries can contribute more on top of this, they can't take it away. So the level I'm getting from the gel still isn't great. Definitely not decreasing doses as I've been through all the earlier doses without that helping. Only increasing now...

[Hurdity]

Hi joziel - the product info for oestrogel says (in the tests they carried out on a pretty small sample of women) steady state  was reached after 3-5 days - the tests were carried on on post-menopausal women for obvious reasons.

As you probably know symptoms are more important than actual levels and 283 pmol/l is a pefectly reasonable oestrogen level if it is alleviating your symptoms (if you are post-menopausal, but if peri - depends where in your natural cycle you are....) - and sorry to hear that you are still suffering. What night-time symptoms are you still experiencing that makes you feel the dose you are taking is inadequate?

Hurdity x

[Mary G]

joziel, that is a very low reading for 3 pumps of gel and exceptionally low for 4 pumps.

To give you an indication, I get a consistent level of 300 pmol on one pump of gel. In my case, it's about right because I'm 62 and very post menopause but if you are still in peri menopausal it might not be enough to control your symptoms.  I would have needed at least two pumps to control my sweats 10 years ago.

One thought, is your absorption problem due to the type of gel you are using?  I use a Spanish gel called Oestraclin (brilliant stuff) and in theory it's the same strength but perhaps there are variations.  When I bought my gel in the UK I used Oestrogel then Estrogel (a round blue container).

[Kathleen]

Hello ladies.

I have recently had my Oestradiol and testosterone tested and I wasn't given any advice about application or the time of the appointment. This would have been irrelevant for testosterone as I don't use it but I do apply a 1mcg sachet of Sandrena gel to alternate thighs every morning. 

I think the lack of guidance about testing times is due to ignorance about the products and HRT generally. My experience has been that the medics don't know enough to give any advice one way or another.

I am post meno and my Oestradiol came back at 174pmol/L which I believe is low and this is confirmed by my range of continuing symptoms. I am having surges of panic and flushing through the day now to add to my mood swings and tearfulness so it's fun, fun, fun in my house the moment lol! Oh and I hate my husband again which is also a sign ot low Oestrogen for me. Bizarrely I have no nighttime symptoms at all...yet.

Joziel - I can see why you are now focusing on increasing your dose to get symptoms under control. The only information I had about the gel was that it lasted for eighteen hours so perhaps applying once every 12 hours would reduce any fluctuations.


Take care ladies.

K.

[joziel]

Hi joziel - the product info for oestrogel says (in the tests they carried out on a pretty small sample of women) steady state  was reached after 3-5 days - the tests were carried on on post-menopausal women for obvious reasons.

As you probably know symptoms are more important than actual levels and 283 pmol/l is a pefectly reasonable oestrogen level if it is alleviating your symptoms (if you are post-menopausal, but if peri - depends where in your natural cycle you are....) - and sorry to hear that you are still suffering. What night-time symptoms are you still experiencing that makes you feel the dose you are taking is inadequate?

Hurdity x

Thanks Hurdity. So that result should be reflective of 4 pumps for me then.

I'm peri - and that result was from day 16. My night time symptoms are: Heart beating hard and fast. Inner tremors - at a minimal level this feels like a buzzing in my feet and at worst it's whole body vibrations that made it feel like the bed was moving under me. Hypnic jerks (just as I'm falling asleep, I jerk awake - this happens every time I start to drop off until my brain stops me from falling asleep). And insomnia, unsurprisingly.

This has all got a lot better since I've increased my estrogen to 3 and then 4 pumps and also started on a low dose of T3 (as thyroid tests found I had low T3 and high rT3). I'm still not sure to what extent the symptoms are thyroid and to what extent they're estrogen. I have more thyroid bloods to do tomorrow and they will increase my T3 dose if needed after that. There's nothing actually wrong with my thyroid, I'm just converting T4 to rT3 instead of to T3 for some reason we don't know. The goal is to get things to where they should be and see if my body can maintain that without the T3.

Whilst things have got better and I can sleep much better, it's still all there to some degree. I feel like the symptoms have reduced enough that I can sleep through them most of the time but I often wake in the night around 4am with my heart beating a little hard and then can't go back to sleep for several hours.

Complicating all this, I have a history of endo so I have to be careful with increasing estrogen. I now think that my own ovaries sometimes contribute a spurt of it and I get some symptoms for a few days. I used to think this was the HRT causing the endo symptoms - but given the consistently low estrogen bloods I get done, I think it's my ovaries doing erratic things at certain points in the month... I'm already on 3x utrogestan capsules orally from day 15-26. I'm going to add in one capsule from day 9 this cycle, before that. I might need to go continuous even during peri (as told by my Newson dr) but trying not to because I will bleed erratically. When I have zero endo flares for a cycle, I'll increase the estrogen....

[Hurdity]

Wow joziel - I'm sorry to hear all of that. It sounds pretty complex. Straight away I have to say I know nothing about the interaction between thyroid function and menopause/HRT and Wrensong is the one for that.

Those symptoms of heart beating fast and tremors and buzzing so sound more like thyroid than classic menopausal symptoms though low oestrogen can cause palpitations though I would have thought at a lower level than needed to control flushes if you see what I mean ie if it is controlling flushes and sweats then unlikely still to cause palpitations I think?

The whole issue about low or high oestrogen. I do stand by what I said - that is a perfectly respectable measurement though I do agree that if you are younger, then you might need more overall. The thing is absolute oestrogen measurements are no guide whatsoever to symptoms - no correlation at all.

eg Kathleen's measurement of 174 pmol/l - is not expecially low but at the lower end of post-menopausal levels in older women I would suggest. Mine was measured some years ago when I was in my 60's and when I was due to change my patch and was around 90 pmol/l but in the middle of patch change time was something like 190 ( can;t reemember exactly). When I was younger it was 212 once when measured. At no time have I experienced flishes or sweats escept when I;ve come off HRT or when I reduced dose permanently ie the fluctuations between patch change do not affect me, though following the 90 measurement the doc increased my patch to 75 mcg though I actually cut some off so have 62.5 mcg. It is very much an individual thing.

For osteoporosis protection I did read a paper some years ago and haven't been able to find it since, that suggested 165 pmol/l was the minimum objective measurement for osteoporosis protection, though private consultants always quote higher - (I've never seen a paper about this though).

Re endometriosis - yes continuous progesterone is recommended but 300 mg is a lot - if you took it all the time maybe you need only take 200 mg, if you could cope with that amount daily?

In view of the endo and your oestrogen reading I would first have a look at the thyroid issue - as you say you are having bloods done and hopefully a tweak in your dose may help.

As a matter of interest where are you being treated for thyroid - I know treatment on NHS is very poor because the nuances of Hasimotos and T3 vs T4 and all of that are not investigated in detail - or maybe they are, if you are referred to a specialist?  pm me if necessary.

All the best with trying to sort this out!

Hurdity x

[joziel]

Hi Hurdity, yes it's a bit of a nightmare trying to pick my way between HRT, endo and thyroid stuff  Not to mention different doctors.

I'm with Newson for menopause stuff (although I get what prescriptions I can on the NHS) and with The Thyroid Clinic for thyroid stuff. Dr Conway is the dr there and she's great. She's an NHS GP half the week and the other half runs this private thyroid clinic mostly online. (Online consults and then blood packs are posted out to you to take to your nearest phlebotomist. So she can see people around the UK.)

You're right, the NHS will only test TSH and if that's normal - tough. Mine always was. I even did the Medichecks advanced thyroid panel, which was also normal. The one test it doesn't include is rT3. So I'd decided all this definitely couldn't be thyroid related and moved on... It was someone in some Facebook group who told me I really had to test rT3 and that they had had similar symptoms with everything else fine except rT3, so in some final effort I went to The Thyroid Clinic and got rT3 tested and everything else re-tested. My rT3 was sky-high (33) and my free T3 was pretty low (3.1, where that was the bottom of the range). Dr Conway wasn't sure it was thyroid causing this but prescribed me some T3 in a sort of 'if it gets better it's probably this' way, and things did get a lot better. But not totally okay... So I might need more T3. Hence repeating the thyroid bloods today... after 6wks on T3.

T3 is ridiculously expensive so I'm really hoping I don't need it long-term. Frequent bloods and private appointments are a nightmare too. I've had to do it not just for menopause stuff but for thyroid too, it makes you wonder if there is anything available on the NHS these days. My partner has his ears syringed by a GP (wax build up) but apparently this is no longer a service the NHS is providing either...(!).

I'd like to not use continuous utrogestan if I can, not because of any side effects - I'm totally fine, however much I have of this stuff(!!) - but because of erratic bleeding which will happen and might result in unnecessary worry and tests. I was thinking to do something like 1 utrogestan capsule days 7-15 and then 2x utrogestan capsules (or 3?) days 15-26. Or I could just do 2 capsules continuous but stop to allow a bleed every month, kind of like the old '25 out of 28 days' idea....