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[SarahtheFlower]

Hi There,

I'm new here (full(ish) history on the 'introduce yourself' page).

I'm 43 and on three pumps of estrogen gel a day.   I still have brain fog, memory problems, fatigue and low libido .  I also have achy boobs that seem to be growing    I went for a run this morning and my trusty old sports bra wasn't quite 'doing the job'!

So, what do people think?  Too much?  Not enough?   How do you know you're on the optimum dose?

I'm wondering if testosterone is what I need given the low libido?     

Look forward to hearing your thoughts ladies 

Sarah.

[Bandango42]

Hi Sarah

I hope you don't mind me jumping on this thread,  I actually came here to ask a similar question. I'm due a review of my hrt with my GP,  4 months in. I'm on evorel 25 patches and 200mg of utrogestan for 14 days. I'm wondering how do you know if you're getting enough also. My aches and pains have gone,  I'm sleeping better,  my hot flushes and night sweats have disappeared but I still don't feel 'me'. I'm very low a lot of the time,  have no energy,  my memory is terrible and I have no motivation to do anything. I have no idea if I need more estrogen or whether this is it in terms of feeling better? Hope you get some answers/advice soon x

[joziel]

Don't forget the importance of testosterone. Brain fog, memory problems, fatigue, low libido, all scream testosterone to me...

Hot flushes, vaginal dryness etc = more estrogen.

There seem to be loads of GPs who refuse to prescribe testosterone and so women are stuck trying to increase or decrease estrogen and wasting a lot of time focussing on the estrogen side of things, before sorting out the testosterone.

IMO the testosterone side of things is pretty simple. It's a standard dose every day. You are unlikely to get side effects even if the dose is too high (and you will know that when you do the compulsory blood test at 3 months) and it doesn't cause bleeding. It's a pretty simple thing to get set up. After 6 months on testosterone if you still have symptoms, you probably do need to adjust the estrogen. That's what I think anyways....

You will probably need to STRESS your low libido to your GP - even if that doesn't really bother you - because at the moment that's the only thing that testosterone can be prescribed for. Even though we know it does way more than that. So mention the other stuff but emphasise the libido.

If your GP won't prescribe testosterone then you'll have to go privately to get it. You shouldn't have a problem with that, except for the cost.

[SarahtheFlower]

Hi Bandango,

I am so, so pleased you made contact.   I feel so very alone in all of this due to my age.   There is a certain comradeship amongst older ladies I think, but all my friends / work colleagues are about my age and frankly have no idea about the challenges I have been facing in terms of brain fog, etc.       My mum is in her 80's (she was 42 when she had me!) and her generation seem not to talk about it.   When i ask what it was like for her she says she doesn't remember - I think she just doesn't want to talk about it.

Someone in another thread mentioned the Daisy website for people with early meno, so going to check that out next.   

I had a quick look at your earlier posts and note your period problems and that you are on a patch.   My knowledge is very limited, hence here asking questions, but from my experience, I was on the combined contraceptive pill for many years becuase my periods became very close together (like yours).   The one doc I spoke to recently said that sometimes the combined pill is used to treat mild meno symptoms.   It has the advantage that you can control very easily when your periods are (you can run strips together so that you don't have a period at all if you want).   I don't know how 'low' your hormones have to get before this is not an option.   I went straight from the combined pill to patches and then didn't have a period for 6 months - I interpretted that (maybe wrongly) that my natural periods had in fact stopped (you can have a withdrawal bleed if you don't run strips together).   It just makes me wonder if, if your're still having a natural period, maybe your hormones are not too depleted that the combined pill might be enough to get them back up?  I do remember, however, when i first started them i bled for about a month non-stop... 

Also, i thought they were phasing out patches in favour of gel...?

[SarahtheFlower]

Hi Joziel,

Many thanks for coming back to me.   Your post confirms exactly what I was thinking!!!   I am due to go back and see the doc in a couple of weeks and my fear is that she will want to increase the estrogen.  I'm already on 3 pumps and I hate having to cover my body with all this cold sticky stuff - yuck!  Also, my boob issues are telling me that maybe I'm on too much eastrogen.  I know they want to get the estrogen right before adding testosterone into the mix.   It just feels like so much time gets wasted - tweek this and wait 6 months - that hasn't worked, so we'll tweek that and wait six months.   God, I'll be 80 by the time I'm fixed!    

[sheila99]

You can ask for a referral to an NHS meno clinic to get testosterone though there may be a long wait. GPs won't normally prescribe it because there isn't a product available on the nhs licensed for women so they are personally liable if anything goes wrong. They usually only prescribe it for low libido.

If your boobs are sore on the oestrogen dose you're on increasing it may not be a good move. Some people find they need to increase more slowly so might be better reducing then working up by half a pump at a time. If other symptoms went on a lower dose that was probably the right dose for you.

[SarahtheFlower]

Hi Sheila,

Unfortunately, there arn't any NHS meno clinics where I live (Herefordshire), only one recently opened private one.   I'm seeing my doc next month.   I press for testosterone and if she won't play ball I will go private...

Re your 2nd para, yes, this was my feeling too.   I've been on the higher done for some weeks now and my boobs have not settled down, although they ached when I first started on the patches too and that was a much lower dose I think.  Thinking about it, I don't think they've stopped aching since I started HRT!

[joziel]

It's important to say that not all GPs "want to get the estrogen dose right before testosterone" - Newson Clinic prescribe testosterone from day 1 of anything, to be started alongside estrogen.

We just don't know enough about this yet, so if you hear that from a doctor, it's just one theory. It's not necessarily the truth.

I feel the opposite - getting the estrogen dose right is beset with so many side effects and up and downs and so on, it is far easier to get the testosterone started and on board, and then worry about the estrogen!! I don't buy the whole 'testosterone gets converted to estrogen' thing. Clearly Newson don't either.

[Cassie]

The only way to be sure is with a blood test. I would reduce to 2 pumps a day and see if that makes a difference.

[Bandango42]

Hi Sarah

I hear you re the age thing. Most of my friends are older than me and have yet to show any signs of menopause. My mum is great,  she started the menopause at 40, as did my grandmother so it runs in my family. However,  when she started hrt she said it was a wonder drug and made her feel like superwoman so I had very high expectations which haven't played out unfortunately. I have no idea what I need in terms of hrt,  whether I'm getting too much or not enough. I'm doing ok on it but I don't feel amazing at all. I feel like a different person to 6 months ago and I hate it 😢 xx

[joziel]

You can't tell even with a blood test. Some women might get 300pmol on a blood test and feel great and some might get 300pmol on a blood test and feel awful because they need 800pmol to function.

Go by symptoms. Use what you need to treat symptoms. If you find a level that fixes your symptoms and you want to check that it's sufficient for bone health, then do a blood test. But you can't use a blood test to decide how much you need. (Learnt that from experience.)

[2cats]

With regards to gps prescribing testosterone, the rules changed on May 31st this year and now in certain areas gps have the go ahead to do this. However, it’s a postcode lottery. Where I live, gps can do this but you will need to check. Look up formulary for your county. Good luck.

[Nas]

The whole thing is a hideous minefield! Trial and error with a whole load of patience thrown in for good measure!

Definitely go on symptoms. I don’t think bloods prove much personally.

[SarahtheFlower]

Hi Bandango,

Glad to hear you've got support of family - no family history for me, although several aunts did not start families, so it makes me wonder if there were fertility issues in the family or whether they chose not to have families?   I too feel a different person to what I used to be.   I paint as a hobby, but when i started HRT I seem to have completely lost all creativity or motivation to do anything.  And my brain fog makes me look 'm thick.  Memo is crap isn't it?!   

Hi 2Cats,

Thanks for that. I've looked up the formulary for my county and it says it's Amber and says: "Considered suitable for primary care prescribing following specialist initiation/recommendation".  Does that mean the doc will need to send me to see a 'specialist'? 

Nas - thanks - and agreed!

Sarah. 

[joziel]

Yes they will probably want to send you to see a specialist first and then will continue it. You could just see a private menopause doctor and get them to prescribe and then write to your doctor to ask them to continue it - that might be easier than waiting months to see a specialist on the NHS.