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[soniad]

Hi everyone,

I wanted to get some advice on high doses of estrogen vs. absorption rates.

I started HRT when I was premenopausal. Started on 25mcg Estradot and then, as years went by, increased to 50mcg.

Just after my 50th birthday I noticed a significant change in my sleep, and started to get recurring psoriasis in my ear canals, leading to recurring infection and having to take antibiotics every 5-6 weeks.

I went up to 75mcg and allthough I still get the psoriasis (flares up more when I'm taking the progesterone), it's not as bad and rarely gets infected, as long as I treat it with steroid cream.

This year, just after my 51st birthday my sleep started playing up again.

Tests revealed a blood level of 192 for Estrogen.

So, I'm now seeing a specialist who has changed me to a compounded cream. He started me at 1.5mg and immediately I knew it was way too low, so I doubled the dose - 3mg.

The sleep is good again.

Latest blood level reading is 254, which is the highest reading I've ever gotten on HRT.

My question is....My doctor says 3mg is an 'extremely high dose' and he rarely prescribes more than 2mg.

Yet in the same breath he says he aims to get his patients readings around the mid 300's.

I would have thought it would be the blood readings that should determine what dose you should be on, as different people absorb in different ways.

I'm just trying to get my head around this.

I'd really like to take a little more estrogen to see if it helps my ear canal problems - I don't think my blood reading is especially high, so what would be the harm in upping it a little more?

Love to hear your thoughts, especially from ladies who are taking high doses.

Cheers

Sonia

[Hurdity]

Sorry to hear about your problems soniad.

Firstly to say that despite the results you got, compounded creams are not recommended for HRT because they are not standardised  and can give very variable results and are also pretty much a commericial rip-off ie the docs are charging a high price for hormones that can be got very cheaply on NHS.

It is a pity that you did not seem to be absorbing oestrogen very well from patch Estradot.

Normally blood tests are not necessary to determine absorption and especially during peri-menopause when women vary so much from hour to hour and day to day. In post-menopause they cna be useful if women do not seem to be absorbing because symptoms recur even on a hoighish dose as in your situation. However compounded is not the way to go - why not go back to your doc and try the gel - which is a proprietary tested way of getting oestrogen - and is applied daily and absorbed through the skin just as creams are.

I assume your oestrogen readings are in pmol/l or are they pg/ml?

Also what progestogen are you taking or have you a Mirena or had a hysterectomy?

Could there have been other reasons for your sleep problems while taking the 75 mcg oestrogen?

Hope you don't mind the questions but just trying to get a picture of where you are in menopause and your situation!

I take 62.5 mcg Estradot and have no symptoms and my levels are probably betwene 200 - 300 (lower estimate  I expect!) - there are women on here who do have very high levels of oestrogen and need them to feel happy and symptoms free!

Hurdity  x

[soniad]

Firstly to say that despite the results you got, compounded creams are not recommended for HRT because they are not standardised  and can give very variable results and are also pretty much a commericial rip-off ie the docs are charging a high price for hormones that can be got very cheaply on NHS.

I understand where you're coming from Hurdity. But I'm in Australia and the only alternative we have is Sandrena gel. For many years I've been doing this all on my own and when I asked the doctor if I could get some Sandrena she threw a hissy fit and said I should see a gynae.

I've seen gynaes before and they're worse than useless. They know less than nothing about HRT.

This guy I'm seeing is very knowledgeable and I trust him. Yes, I'm paying more but I want a customised dose and don't want to have to be slathering my whole body with 3 X 1mg sachets of Sandrena every day.

I assume your oestrogen readings are in pmol/l or are they pg/ml?

Yes they are:)

Also what progestogen are you taking or have you a Mirena or had a hysterectomy?

200mg  oral micronised progesterone. Reading was 81.6!

Could there have been other reasons for your sleep problems while taking the 75 mcg oestrogen?

.

No. I've had full blood tests including thyroid etc...I have no stress in my life. It improved immediately after taking the 3mg cream.

Hope you don't mind the questions but just trying to get a picture of where you are in menopause and your situation!

Not at all! I so appreciate your advice and guidance hurdity.

So I guess what I'm asking is:

If one person's taking 1 mg of gel and getting, say a 350 reading and another person's taking 2mg of gel and getting 200 reading, then who, technically is on a higher dose?

I'm trying to work out if if it would be 'dangerous' for me to go a little higher than the current dose.

[Joaniepat]

Soniad, your doctor's comments don't make sense to me either. I was on 3 pumps of Oestrogel (a medium high dose) and achieved less than 100 pmol/l. I want to achieve at least 200 pmol to avoid osteoporosis. The menopause clinic has switched me to 2 mg Sandrena to see if I absorb this better. If not I will try a patch. As you say, people absorb products differently. I would be asking the specialist how he proposes to get you to the mid 300s.

I don't see how it could be "dangerous" to increase your dose, but of course that's up to you!

All the best,
JP x

[soniad]

I don't see how it could be "dangerous" to increase your dose, but of course that's up to you!

Exactly Joaniepat!

Surely it's the amount of estrogen actually registering in the blood that should determine whether or not I should go up, not the dose itself!

I'm lean as well, so maybe I need more than the average person.

The doctor reckons I'm still in perimenopause though (he can tell by my fsh levels) and he said because the estrogen still be fluctuating I shouldn't go up.

[dangermouse]

In peri you may find that your next blood test is double that and the next is half as your own hormones will be up and down regardless of what you take. It's best to go by how you feel so it sounds like you have it just right now.

[soniad]

In peri you may find that your next blood test is double that and the next is half as your own hormones will be up and down regardless of what you take. It's best to go by how you feel so it sounds like you have it just right now.

Yes, sort of....except for the ear canal psoriasis.

That's why I wanted to increase slightly.

I've had several blood tests and all have been below 200 up until now.

[Hurdity]

Hi there - as i said before in UK docs don't normally do blood tests so the dose you are on is the dose you apply as otherwise there is no way of knowing apart from symptoms. In your position they might do blood tests. However as women absorb differently someone can technically seem to be on a very high dose but actually is not getting that amount, so yes the amount you are getting would be the amount your blood registers, or the amount which controls your symptoms irrespective of the patch size, amount of gel etc.

If your doc says you are still peri-menopausal then even more reason that blood tests will tell you nothing - if you are still having some sort of cycle then they will fluctuate enormously. If you are still peri-menopausal then you would be likely to get some breakthrough bleeding now and again as you ovulate, unless the progesterone was so high as to prevent any thickening of the womb lining.

I still think you would be better off at a regular doc. You could end up spending thousands and be no further on.  Have you thought of taking a tablet instead? If you are not absorbing very well transdermally you may well do better taking it orally. I appreciate your feelings about the gel but it masy well be absorbed better than the cream and in any case you still have to apply the cream? 

Do hope you manage to resolve this!

Hurdity x

[soniad]

Thanks Hurdity.

I don't want to take a tablet, prefer to do it transdermally.

At one stage I may try the gel.

Thanks again

[SueLW]

I used the compounded creams for 3 years.  They were OK at first but by the time I switched I wasn't getting any relief from them, even though I'd tried 2 different base creams.  My bloods were tested and I had a result of 44 for oestrogen.  Very low, despite using a lot of cream a day.  I switched to Estrogel in the summer and it's better for me.  I can tell I have some now.  I'm currently on 3.5 pumps a day but suspect I will need to up that at some point.  Absorption is the key to any of these products. 

I thought, great!  I can get the gel on the NHS at last and stop the expense of the cream.  Only to be told I need to use testosterone as well and I have to pay for that as I'm using the only UK and Europe wide approved female testosterone cream (made in Australia!). 

[paisley]

I agree that everyone absorbs things differently. For me the gels don't absorb good despite at one time using 4 pumps of oestrogel. For me it is the patch or transbuccal which isn't licensed. I have eczema in my ears. Only had it since meno which too makes me prone to infections. Didn't know it was a symptom of meno

[soniad]

I used the compounded creams for 3 years.  They were OK at first but by the time I switched I wasn't getting any relief from them, even though I'd tried 2 different base creams.  My bloods were tested and I had a result of 44 for oestrogen.  Very low, despite using a lot of cream a day.  I switched to Estrogel in the summer and it's better for me.  I can tell I have some now.  I'm currently on 3.5 pumps a day but suspect I will need to up that at some point.  Absorption is the key to any of these products.

Hi SueLW, I was using patch and not getting great results from that. The only reason I want to use a cream is to get a customized dose instead of having to slather on 3.5 packets of Sandrena gel, which is the only thing available here in Aus. I wish we had estrogel. I'd love to try it.

I have eczema in my ears. Only had it since meno which too makes me prone to infections. Didn't know it was a symptom of meno

Interesting Paisley! I can't say categorically that it is a symptom of meno, only that I've never had it before in my life but when I turned 50 it suddenly appeared, was really awful BUT has gotten better since I upped my dose of Estrogen.

[Noheroicsplease]

I'm on 75mg Estradot patch every three days and my sleep is awful and has been awful throughout all variations of HRT.

My meno doctor says sleep is complicated and can't always be fixed.

I wasn't absorbing anything 6 weeks ago via Estrogel, but have another blood test on Monday to see if estrogen levels have risen. I also take Tostran now.

I intend to get levels up to 200-300.

[soniad]

I'm on 75mg Estradot patch every three days and my sleep is awful and has been awful throughout all variations of HRT.

My meno doctor says sleep is complicated and can't always be fixed.

I wasn't absorbing anything 6 weeks ago via Estrogel, but have another blood test on Monday to see if estrogen levels have risen. I also take Tostran now.

I intend to get levels up to 200-300.

Yeah, I've heard that some ladies here don't get improvement with sleep on HRT.

But it works brilliantly for me.

My Doc recommends melatonin for sleep, and says it has anti-cancer properties as well.

But I'm wary, as there are no studies about the safety of long-term use of melatonin.

[Noheroicsplease]

I do take melatonin spray sometimes - it doesn't really work for me. I am also wary as it can be addictive.

I take Valerian and that can be good. I'm looking at two sleep compounds (non prescriptive) on my desk which i've recently bought, and have done jack shit for my sleep.

I am doomed to terrible sleep forever more! You are very lucky, Soniad, that it can offer you a reprieve. Do whatever you can to sleep well.