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[Clarella]

Sorry, epic post. Asking a question I asked the other day in a different way.

I started hrt in nov at 44. 37.5 patches. Still had cycle so utrogestan cyclically and I tried vaginally from the start.

Felt impact on aches immediately and v bouyant after a couple of weeks. Things seemed to start to worsen after booster jab and catching covid in Jan which left me with v mild long covid, though I think that’s resolved now. Raised to 50 in February.

Started to go down hill more at Easter; lack of stamina and severe loss of libido and dryness. Blood test showed 134 in May and I went to 75 patches, though I had some issues with leg and feet aches, swelling etc. caught covid again though bounced back better, some fatigue for 5 weeks.

I’d asked about testosterone in May and Gp said we have to “maximise oestrogen first” and seemed to think that would resolve it.

A key issue for many years has been joints and aches and pains an stiffness, no matter what I do, plus crippling fatigue. Fatigue and brain fog is much better but joints still can be creaky. Also burning and tingling hands and feet which comes and goes.

I’ve moved to 87.5. Gp wasn’t going to move me higher after latest test due to side effects I’d had going from 50-75 and seems to have forgotten previous discussions after Easter around libido and fatigue, but agreed to the edging up slowly idea. I’m still having some over heating / insomnia nights, especially on the third night after at the end of a patch. (Doing 3 days and think I may now change in evenings.)

However, I am concerned that even 100 patches may not be enough, I’m not even sure I’ll hit 400. (She’s said 400-600 is ideal.)

Under the nhs what is max oestrogen? Do I need to go private? I’m supposed to be on Newson waiting list but taking ages and would rather go via nhs.

Am I being really impatient? And need to see how symptoms are when I’ve been on 100 for some time?

I’m now tempted to move to 100
More quickly tbh. I think the heat made water retention worse in the summer.

(Vit d and other tests to be done on medichecks, postal strike causing a delay there. I’ve had loads of thyroid and b12 tests but just checking vit d and active b12.) 

[laszla]

Clarella it's very possible that you need more estrogen, albeit increases should be made incrementally, sticking to 2-3 months on a higher dose before adding more.
I'm a poor absorber of estrogen and have been prescribed up to 6 pumps of estrogel daily at Nick Panay's NHS clinic - which I think is equivalent to 150 in patches. I've been advised to get estradiol up to 800 pmol for my particular symptoms but am only in the 500s - still a big improvement on my pitifully low numbers I had for years on 2 pumps of estrogel. But even this increase has finally helped symptoms (apart from the vile progesterone phase)

[Clarella]

Thank you.

I’m trying not to get hung up on numbers but I’ve normalised symptoms for so long that I don’t know how much more I could improve if I could go higher. What being normal and well is. And therefore whether to push for that or accept my limitations.

I’ve been hypothyroid my whole adult life and that wasn’t always well controlled. And I think peri for 8 years but a baby/ pregnancy reversed some issues temporarily. So I find it hard to recognise what well is.

May I ask what symptoms you’re aiming to tackle at that higher level?

[laszla]

Clarella I know exactly what you mean about almost forgetting what 'normal' feels like. Since finally getting my estradiol levels up recently after years of non-absorption, I have experienced moments, even the odd couple of hours here and there, of feeling normal and it's almost surreal to remember in your body and mind what that feeling is because it's been so long since you felt it.
I still have a long way to go as the second half of my month is still terrible (the progsterone 10 days and bleed 5 days) but at least now I remember and know what I should feel like and that increasing my estrogen can achieve this.
The symptoms I'm talking about are mental - extreme anxiety and fear mostly, some depression. Also have osteopenia which my consultant says can be reversed by increasing estrogen.

[joziel]

Clarella, there is no max dosage of estrogen. There are women on 250mcg with 2x 100 patches and a 50 patch....

There is a max LICENCED dose, which is 100mcg. Some GPs may be reluctant to prescribe above that unless they are menopause specialists. That's not because it's dangerous, it's just because they get a bit nervous about it because it's not licensed. And you may need extra progesterone if going above 100mcg.

If I were you, continue edging up slowly and if you get to 100 and still have symptoms, get a blood test done. If it shows low levels you might consider trying gel instead of patches, since women can absorb one better than the other... If that doesn't work, you might just need more estrogen. You can't start to worry now that you will need more than 100, since it's impossible to predict that. You are far away from 100 at the moment and small dose increases can make big differences in terms of how you feel - so it's premature to worry about that now.

If you want to go to the Newson Clinic, give them a ring or email for any cancellations. I was on their waiting list and waited ages, then got desperate and emailed to see if there were any cancellations and I got offered a video call the next week. If you are happy for a video call, there is less of a wait for this than in-person appointments there.

[Clarella]

It’s so hard Laszla. I’m sorry to hear you’ve had the same.

Slightly low mood and lack of motivation, low executive function, confusion expressing concepts sometimes. sometimes fear or excessive apprehension about things I used to be confident about is an issue. The rest is joint weakness and days of fatigue. Low libido and it’s been v dry down there, I have ovestin. Sleep patchy.

I’ve had what feels like chronic fatigue for several years but I do think is peri. As some things have improved on hrt.

Thanks Joziel, I suppose I meant, what would nhs class and maximising oestrogen and checking symptom before trying testosterone. Gp said bloods of 400-600 and I know Gp would be unlikely to go above a 100 patch.

But you’re right I do have to wait till tried the 100 patch.

I’m on the Newson wait list but yes could try calling for phone call. I suppose I’m conflicted as I know the Gp has prescribed testosterone before so potentially I could wait and see how I go. I also worry that testosterone won’t be what I think it will be. I’ve lost a lot of confidence though. Also hair on top lip are mo more! So I suspect possibly lower testosterone.

I do query if testosterone gets converted to oestrogen? Is that why we max oestrogen first? I know Newson prescribes both together. And I’ve heard of some women only using a little testosterone.

I have hypermobility and do feel testosterone could help there. Exercise is v challenging. I do need to be fit as two young active boys and a very active job, though only 2 days as I can’t manage more physically. So being more capable would be very helpful for my life.