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[JoannFran]

Hi ladies

I had an online appointment with a meno specialist on weds because my anxiety and heart palps are making my life a living hell.  She thinks that my estrogen just isn't high enough (the max it's been on a blood test is 393).  I'm currently on 100 evorel patch plus utro for 12 days.
Anyway, she has prescribed me one pump of Lenzetto per day (she's also given me cyclogest 200mg to try vaginally which I will do next cycle). 

Today I used the extra pump of Lenzetto for the first time and have felt very jittery all day with weird head sensations and lots of ectopic heart beats and just generally feel wired.

I will persevere for as long as I can with the extra pump in the hope it subsides.  My question is how long should i keep going for until I know it's not working?  Has anyone had an increase in symptons initially when increasing estrogen but then it's been beneficial?

Interestingly the dr was also telling me that there is a new progesterone (synthetic I think) that can be tried.   She didn't go into much detail as we are trying the cyclogest first. 

Thank you x

[Hurdity]

Hi JoanneFran

If you are post-menopausal then 393 pmol/l is a very respectable oestrogen level! If you are peri then the level varies throughout the cycle and tests won't really tell you anything. That's not to say of course that you won't experience symptoms as the absolute level at which the "sweet spot" is achieved varies from woman to  woman. However I would be suprised if inadequate oestrogen is the cause of your anxiety and heart palpitations, at that level - but I stand to be corrected ! Do you have any other symptoms? Side effects from sudden increased oestrogen should settle pretty quickly - after a few days maybe?

Hurdity x

[JoannFran]

Thank you so much for your reply.  I am 49 and perimenopausal.  I've been trying to figure out what is the cause of the anxiety and the palps and drs keep telling me to up the estrogen.  I've always wondered if it goes too high and that's the problem.  Don't have many other symptoms apart from itchy ears, burning tongue and feet (Sometimes), forgetfulness, strange head pressure and the awful anxiety and ectopic heart beats, which have become worse and worse.  Originally on HRT it only happened at certain times of the month but is now with me almost all the time and I just don't know what to do.  I feel like I have no joy for the future :-(.    I think I'll persevere for a week or 2 and then if no improvement I'm going to come off of HRT completely and see what happens. 

[bombsh3ll]

I agree with Hurdity that doesn't suggest under treatment to me - everyone is different but that's almost identical to mine (44 year old on Zoely) and I am really happy with this level as it equates to a typical premenopausal level in the early-mid follicular phase. Definitely bone and heart protective.

There's no harm in trying to head a little higher, some do feel better mentally but if adding a bit of gel is making you feel worse, you may just have to accept that not all symptoms are due to hypoestrogenism - plenty of premenopausal women also suffer with anxiety.

Other things to look at would be the progestogen, as you are doing, and also testosterone, particularly with you mentioning a lack of joy.

I would caution against just throwing in the towel and stopping it abruptly because if we are used to having estrogen and it suddenly plummets all hell can break loose! At least taper gently, but be mindful of the long term health benefits of estrogen even if you don't think it's doing very much for you in the short term.

[sheila99]

They can be symptoms of too much oestrogen as well as too little. When it was cyclical was it when your own oestrogen was high or low? That might give you an indication of which it is. Is it possible to use a part pump? It might be better than a full one.

[Hurdity]

Hi JoanneFRan

I just wondered what makes you think you are still peri-menopausal - since looking back at your posts I see you started HRT 3 years ago - though I cant see if you said what your cycle was doing back then? If you are still peri-menopausal then around the time of ovulation your own oestrogen level could go very high and the HRT will add to it as it is not sufficient to suppress the cycle, which could lead to symptoms of excess oestrogen over those few days. though you say your symptoms are now constant....

If you are post-menopausal then potentially a different approach might be needed eg you could try continuous vaginal progesterone - if you could tolerate using it vaginally all the time!This would then give you a consistent dose of both hormones. If you really wanted then you could have another blood tests (if you are post-meno) and would give an indication of levels.

Maybe there is another cause for your anxiety, palpitations? Have you had thyroid tests? Iron?

Hurdity x

[JoannFran]

Good morning, thank you all for replying.

I’m pretty sure I’m perimenopausal as I still bleed each month (albeit very lightly and only for 2 days). 

The confusing thing to me about the estrogen levels is I tested on day 5 and they were 393 and then I tested again on day 21 and my levels were 269. Theoretically they should’ve been higher on day 21 when my own levels should be up, or at least the same as on day 5.

I’m sure that the anxiety is due to peri because I never had it before and it crept in slowly and has gotten progressively worse over the past 4 years. I’ve had so many tests, thyroid, heart and I have haemochromatosis so my iron levels are always higher.

When it was happening cyclically it was around ovulation and again from day 18 to the beginning of my cycle. I have always had a suspicion that it is when my own estrogen goes too high but I have no idea how to combat that?  How do I go about shutting down my own cycle? Would it only be the birth control pill?

Thanks again for helping me x

[joziel]

Since the average age of menopause is 52 and since you are still bleeding, I think you are right to believe you are peri.

Second, it can be perfectly true that 393pmol isn't sufficient estrogen. My own estradiol was 328pmol recently and my menopause specialist and I have been trying hard to get it up to 450-650pmol because during peri many women need it higher. It is a perfectly legitimate thing to try and you shouldn't be afraid of trying higher estrogen levels. Especially if you have explored lower doses and still have symptoms.

In the US, the most well-clued up providers are also aiming to get women between 100-200ng which is the same range as 450-650pmol. It is only in the UK that there is some stupid belief that people should be great at 250+. This assumption has caused me undue hell for years when working with less knowledgeable GPs who basically told me to lump it with my symptoms.

I am on 12 pumps of gel and that still was only giving me the same serum estradiol as 6 pumps - I wasn't absorbing the extra. I've got some Sandrena to switch to and will be, next week - delaying due to a work trip next weekend - but in the meantime I stuck a 50mcg patch on (which I had left over) and I'm getting fantastic sleep, the best sleep I've had in the entire last few years. It's now pretty much proven that my symptoms were due to low estrogen (or fluctuations) even with results around 350pmol.

If your menopause specialist thinks you should get higher, you should 100% try that. But sometimes different estrogens 'hit' you differently, and it's not just about strength but speed of absorption I think. For eg, Oestrogel is often considered quite a gentle estrogen and Sandrena people often describe as giving them a 'hit' or making them jittery. So if you absorb it quickly, it can cause some of these issues. Is there a reason your doctor isn't just giving you an increase on the patch? You can have a 25 patch to add, or 50 patches you cut in half to make 25... If you are good on Evorel that would make the most sense. Perhaps send them an email...

[JoannFran]

Thanks joziel

I really wish I knew if I needed higher estrogen or lower.  The problem is I seem to be very sensitive to any fluctuations so anytime I try to either increase or decrease, I end up getting myself in a tizz and talking myself out of it.  I know that I need to give it time to see if it makes a difference I just can't handle the increase in anxiety and palps that any change causes.  I'm very sure that the utrogestan is making things a whole lot worse so I might stop the estrogen increase for the moment and see if the cylogest makes any difference and then go from there. 

I hope your switch to Sandrena goes well and you get better absorption from it xxx

[Emjay]

Hi, I feel I am going through the same. I have had my estrogen patch upped to 75mg and I feel fuzzy, erratic, poss anxiety is worse, but also have very low mood. Wondering if it will just settle over time. Or maybe it has thrown the hormonal balance out even more. I'm on cyclical Utrogestan and although I feel the negative effects of taking it immediately I am starting to worry that taking it then stopping it is just adding to the hormonal fluctuations (I have had pmdd forever) so hormonal fluctuations have never agreed with me. Still not sure I like the idea of taking Utrogestan daily incase my mood deteriates more(I can't afford for it to get worse, I have 2 young children to take care of)
So hard to know with all of this whether to stick with it and see or whether higher estrogen is just too much and it's not actually what we need.
I wish there was a test that was reliable so it's not such a guessing game all of the time.
I am 43 and to some that is early in the perimenopause world but I have struggled with the last 2 weeks of my cycle always and I know that they also use hrt for pmdd aswell in some cases
It's just finding the right treatment for the individual.
So confusing.

[joziel]

I'd encourage anyone wondering whether their estrogen is too high or too low, to get their bloods done during their period.

That is when your own estrogen is lowest and it will enable you to see what you are getting from HRT.

During peri many women need it to be between 450-650pmol. This is much higher than the low 250pmol dose which most non-specialists and NHS doctors think you should be great on. I have been told by NHS doctors that basically I should be feeling great and they can't see anything wrong, with my bloods at 280pmol. It was only via a private menopause clinic that I was able to try higher doses. This got me up to 325pmol but I just couldn't get higher with the gel even though I was bathing in 12 pumps a day.

However, I stuck a 50mcg patch on - along with that 12 pumps of gel - and I've just had the best sleep ever for the last 2 weeks. This is the best sleep I've had and the most relaxed I've been since all this crap started 3 years ago. I almost don't want to switch to the Sandrena I have because I'm afraid this is going to end when I do, but it's not practical to be on 12 pumps of gel a day...

I now am convinced that I need higher serum levels of estrogen. And I'm equally convinced there are many other women like me out there, struggling because they don't absorb well and because they need higher serum levels during peri - but doctors are telling them everything should be lovely for them now.

Which is all to say, forget about dosages and what you are applying. That is totally irrelevant. What you are absorbing of that, is what counts. Get bloods done during your period to find out...

[JoannFran]

Thanks again joziel.  I did have my bloods done a couple of months ago on day 4 (or maybe 5) when my own estrogen should be at it's lowest and it was 393 pmol.  However I had it done again on day 22 when my own E should have risen and it was 269 pmol.  This just confused me more because surely it should have been at least 393?  Why would the patch give me such varying amounts?  I made sure I changed the patch the day before both blood tests.  I am due a period again soon so I may retest.  Such a confusing time and no idea what to do for the best 

[joziel]

Well that is confusing 

Lots of different reasons that could happen... Perhaps it wasn't 'really' a period that you had, it was breakthrough bleeding? Perhaps you absorbed less from the patch for some reason (drier skin, different shower gel etc etc).

However none of those results are in the range that you'd want to be trialling for symptom-resolution so in some ways it's a moot point. I mean, none of them are 450-650pmol... So it would be clear to me (if I had those results) that I'd need to go higher. My highest-ever result was on a 37.5mcg patch way back at the start of all this, when I had 450pmol - but a few months later on a 50 patch it was 180pmol, so clearly it was my ovaries contributing most of that. And it probably didn't hold at 450 for any length of time either...