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[joziel]

328pmol

What the actual…?? It was 350pmol on 6 pumps. So I’m really not getting much here. I might need to check in with my Newson doctor now and request another product!!

[Nas]

How do you feel in yourself? Are you still symptomatic? What do you absorb from patches? Blimey, 12 pumps.. you would have thought the figures would be in the mid hundreds at least! 

[Hurdity]

I would definitely be wanting to use patches or spray or even oral oestrogen. The very thought of having to spread all that over my body and waiting for it to dry - you must be going bonkers with having to do that! Having said that the levels you record are perfectly respectable but only if your symptoms have resolved ( and I can't remember your age and menopausal stage?).  Is this from blood test drawn at a surgery? Mine have never been that on HRT!

Hurdity x

[joziel]

It was a venous blood draw. I am 46yo in peri with severe night time symptoms...

I am very symptomatic with poor sleep, inner tremors at night, hypnic jerks as I start to fall asleep. It is better than a year ago (less intense) but definitely not ok.

I started out on patches and didn't absorb them well either. I think the next thing is Sandrena gel which is more concentrated. But if that doesn't work, it will be oral estrogen.

I'm not too worried about the risk of blood clots, more that if I ever need surgery they will force me to stop oral estrogen but I could continue transdermal...

[MrsMitch]

Can't offer any advice Joziel but just wanted to say I feel for you with regards to your sleep. I had about 2 or so years of it and mine seems to have changed again recently following a virus. There is nothing worse than poor sleep and, if you're like me, every night you hope you'll sleep better and then the cycle starts, doesn't it. I wish there was a decent treatment for it (and for everything else tbh)
It seems incredible that at such high doses you can't find relief.  Has your Newsom specialist shed any light as to why the dose isn't having the desired effect? Do they think you'll eventually get on top of the symptoms?

[joziel]

I've only just found out that the dose isn't working    I do feel like I've just wasted 4 months, though. My serum levels are the same on 6 pumps as on 12 pumps.

I have an appointment booked for Monday, a 10min 'advisory call' with my Newson doctor, to talk about switching to Sandrena. I think I might well end up on oral though. Sometimes I think I should just switch to oral now because the thought of fannying around with increasing Sandrena and blood tests etc etc for many months just isn't very appealing, seeing I didn't absorb patches well either.

The problem is that I want to come off thyroid meds but the thought of changing around my estrogen doses whilst also reducing thyroid meds just doesn't sound like a good idea to me - so I might now have to delay coming off the thyroid meds. Which I only went on as a trial to see if they helped my night time symptoms.

This is all such a nightmare. Today I stuck a 50mcg patch on because I have some left and I just need to get some sleep before I get my Sandrena in....!

And no wonder I've stopped bleeding - I'm on a high dose of P (300mg utrogestan) because of this high E dose, yet I'm not absorbing the E dose and my serum levels are not high. So with a lot of P and not much E, I'm not bleeding....

[sheila99]

Depending how desperate you are to feel well personally I'd go for oral now. Once you're stable on that you could try sandrena, you'll know within  a few days if you don't absorb it so there'd be no need to wait another 3 months. Given you don't absorb anything else transdermal imo the chances of sandrena being the magic bullet are pretty slim.
  On the plus side at least you don't have to worry about a thickened lining 
 

[joziel]

Yes, exactly sheila    I don't know what to do about the idea of changing to oral now. I think I'm a bit worried about not being able to easily adjust my dose, like I can with a transdermal product. It seems like it's harder to gradually increase the dose because the tablets are 1mg or 2mg (I think) so I'd have to increase by that much each time....

Plus I also worry about having to stop it if I ever need surgery for anything, due to the increased risk of clots with oral.

And lastly oral HRT also can get bound up with SHBG and lead to high SHBG where all your hormones are basically bound and not available to be used. This is a particular concern because I'm also on thyroid meds and T3 is known to do this a lot. I'm supposed to get off the thyroid meds and then this wouldn't be a problem although I might need an adjustment in dose.

So it would be a lot simpler if Sandrena would just work for me. But I'll talk to the doctor on Monday about it and ask her what she thinks about oral vs Sandrena...

[Hurdity]

I sympathise with your plight especially concerning interaction with thryoid issues. Have you posted on the thyroid thread started by Wrensong - she is the best person on the forum to discuss HRT and thryoid with, though she is not on the forum much these days.

As you are so young, have you thought of, or tried one of the contracpetive pills designed for peri-menopause ie Zoely or Qlaira? Qlaira has more oestrogen and is tri-phasic ( different dose of oestrogen throughout the cycle). I know the progestogen is synthetic but it might partly be an answer to your problems, SHBG aside....

Hurdity x

[joziel]

I did participate in that thread some time back yes.

Don't think one of the pills would be a good idea, because the progesterone is a progestin and because I'm then locked into a set amount of estrogen unless I increase with another pill. Better to have both separately, as with transdermal.

[bombsh3ll]

Sorry to hear that but at least you know now.

I really think there's a ceiling level with what can be achieved with gels, and have read a guideline somewhere referring to a specific gel -sandrena I think - stating that increasing beyond 3 pumps did not further increase plasma levels.

With oral, the tablets tend to be small but you could split them with a razor blade or pill splitter.

However you may just find you feel well on a mainstream dose like 2mg and don't need to micromanage it.

[joziel]

Yes, I've heard that it can be hard to get beyond a certain amount. If you heard that about a gel with 'pumps' though, it would be Oestrogel. Because Sandrena comes in little sachets like Testogel.

I seem to be able to absorb Testogel, so if it's the same base ingredients besides the hormones, hopefully I can absorb Sandrena as well....

[Kathleen]

Hello joziel.

I am so sorry that you are still struggling.

I have used Oestrogel in the past and now use  Sandrena. The pump gel is much thinner and runnier but dries more quickly than Sandrena.

I haven't been able to compare oestrogen levels but they are very different products.

I hope you get sorted soon and please keep us updated.

Good luck with your Newson appointment and take care.

K.

[Wrensong]

Hi Joziel, just a quickie - if it's certain you don't need them, could you talk to your doctor about coming off the thyroid meds first & then concentrate on getting your HRT sorted? 

If you have been on thyroid meds your body doesn't need & your metabolism has been running too high as a result, it seems likely this will be contributing to the insomnia, tremors etc you mention.  I also wonder whether a hypermetabolic state (the thyroid meds driving your body too hard) could be causing overly fast clearance of oestrogen, perhaps adding to your difficulty in achieving the higher oestradiol levels you & your MS feel you need?

You are in a difficult situation, I sympathise & absolutely get how debilitating & distressing chronic insomnia is.
Wx

[Hurdity]

I did participate in that thread some time back yes.

Don't think one of the pills would be a good idea, because the progesterone is a progestin and because I'm then locked into a set amount of estrogen unless I increase with another pill. Better to have both separately, as with transdermal.

Yes I understand that but if you absorb better orally then you may not need the higher oestrogen dose?

Yes, I've heard that it can be hard to get beyond a certain amount. If you heard that about a gel with 'pumps' though, it would be Oestrogel. Because Sandrena comes in little sachets like Testogel.

I seem to be able to absorb Testogel, so if it's the same base ingredients besides the hormones, hopefully I can absorb Sandrena as well....

Testogel and oestrogel are equivalent in terms of ingredients apart from the active ingredient, both made by Besins. Sandrena has very different base ingredients - it is much thicker and stickier so it dries in a different way. Slower to dry and therefore maybe absorbs better? I understand that once the alcohol has evaporated with Testogel and estrogel, absorption ceases?

Hurdity x