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[Noheroicsplease]

I'm going to see a consultant on Tue to talk about testosterone and my general horrible mood swings/sadness/misery/anger that descends daily and is making my life (and my DH's) pretty shite.

I'm currently on the mirena coil and Evorel 50. I had blood tests done at the GP. I wondered if anyone could tell me if I'm right in thinking these are very low given I'm on HRT?

My results are:

Serum testosterone level 0.1mmol (0.29-1.67 range)
Serum free testosterone level 1pmoL (3.0 - 33.0 range)

Oestradiol 158pmol/L (45.0-854 range)

Progesterone 0.2nmol/L (5.8-75.9)

[Dotty]

I'm no expert but they look low to me. Your testosterone is not in range so looks like you would benefit from it.

[racjen]

I agree- testosterone particularly looks very low, estradiol I think can vary a lot and at least is within the range, progesterone I have no idea I'm afraid, they don't seem to measure that so often as it doesn't seem to be considered to be necessary for emotional wellbeing, only for protecting the womb lining, which seems strange to me as when you look it up it does have positive effects too.

[Hurdity]

Hi there - I'm off out shortly but just wanted to put up this ref about hormone levels ( haven't read it!)
http://www.hemingways.org/GIDinfo/hrt_ref.htm

Note the units of measurement are different but you can google how to convert from one to the other eg pmol/l to ng/dl or whatever!

Also - progesterone means nothing (if you are post-menopausal) because if you are not ovulating you just produce the usual amount for your metabolic needs like in the first part of the menstrual cycle - so it will always be out of range. The test is designed for fertility. Therefore is irrelevant.

Testosterone - the gynae I saw did not tests for it because like progesterone - the test is designed for much large amounts ( that men have) and is not sensitive enough to distinguish between women's amounts at the bottom end of the range. She went on symptoms alone. ie Classic low or no libido combined with other residual symptoms ( of fatigue, lethargy, depressive feelings, muscle aches etc) that cannot be attributed to anything else. However if it helps you get T then great but probably not accurate.

Oestrogen - yes this is low if you are taking it as part of HRT but yes it varies and might depend when in patch change cycle you had the bloods measured? I would want to have a repeat blood tests re the oestrogen but it looks like you could benefit from an increase in patch byut if so do increase slowly. I think my levels are probably in excess of 200 pmnol/l maybe more now I increased a bit but they haven;t been measured for years!

In haste and apologies for terse nature of post, and any typos!

Hurdity x

[Mary G]

Noheroicsplease, that is a low level of oestrogen and I can tell you that I would not be able to function well at all on that level, particularly with a Mirena coil.

Have you tried Oestrogel?   It is far easier to reach the higher levels of oestrogen with the gel and it gives you maximum control and dose flexibility which you really need with a Mirena coil.   If necessary, you can split the dose by 12 hours to keep your levels up.  I think it would make a real difference.

Having had a Mirena coil myself with virtually no oestrogen,  I have experienced how the progesterone in the coil dominates and causes nasty side effects.

You could probably benefit from some testosterone too but I would concentrate on getting your oestrogen levels up first.

[Noheroicsplease]

Hi Mary

I was using the gel but I didn't think it was doing very much. I didn't feel much different from now.

And when i did too many pumps, I felt weird and my boobs felt like they were going to explode. And they got enormous. As a fitness person, this was awful

I feel like I'm in an HRT bind!

[Mary G]

You probably need to consider an oestrogen implant but you would need to know what level to aim for.

I had breast pain/heaviness with the Mirena coil which is partly what put me off having another one.  I was told at the FPC that the Mirena would not cause breast pain but it came on virtually straightaway although I was pre-menopause at the time and I had my own hormones.  Once I hit the menopause, the breast problems died down but that was probably because my oestrogen levels were extremely low.  I didn't manage to achieve high enough oestrogen levels with the Mirena and patches but chances are if I had, the breast discomfort would have come back.

How long have you had the coil?   It will start running out of steam after a while which is actually helpful.   One other thought, could you swap it for a Jaydess coil?   It has a lower dose of progesterone so you should have fewer side effects and you might be able to achieve higher oestrogen levels before the breast pain kicks off.

[Noheroicsplease]

Mary, thanks, your words are so comforting.

I've had the coil 15 months. It was 9 months until I stopped bleeding!

I don't know what to do for the best. Seeing the consultant on Tue. I feel like coming off everything and going onto anti-deps. I only started taking HRT as I'm young - was 46 last period - and mum has osteoporosis. But i've never had the classic physical symptoms and I feel really low and have no idea what's causing it. The HRT or the hormones!

Sorry to moan. There are many people far worse off

[Mary G]

Nohericsplease, I'm pleased my words have comforted you but I wish I could offer some better solutions.

My personal opinion is that you are too young to be oestrogen deficient and I would not swap HRT for ADs, particularly with your family history of osteoporosis. 

You have had the coil for just over a year so it will be a while before it noticeably runs out of steam.  You could ask for a Jaydess coil which has less progesterone in it and hopefully fewer side effects or you might have to consider ditching the coil altogether.  That would mean having periods again and you would still need to take progesterone but it might be more palatable.  You could do the super low progesterone dose like me and have regular uterine scans. 

Another option would be to ask about an oestrogen implant with the Mirena and see if that makes a difference.  If you end up with breast discomfort you could then make a final decision on the coil. 

From what you have said, it sounds like you are not getting enough oestrogen into your system to feel good but if you do, the progesterone from the coil kicks in and causes the breast discomfort.  The only way around that would be to have the coil removed, spend as much time as you can on oestrogen only and add in a separate progesterone at a low dose, that should mean that you feel better overall and don't get the breast discomfort.  So it's a bit of a trade off really.

[Hurdity]

Hi noheroicsplease - not sure if you saw my post - I responded quickly this morning before going out re your Q for info about levels?

Hurdity x

[Noheroicsplease]

Hello

Hurdity, yes, huge thanks. I haven't had the mental agility to look through those tables yet today! But I will. I hear what you're saying about oestrogen levels and when they are being tested and how the docs test for tesosterone via symptoms rather than bloods.

Mary, thanks very much. I need to see the consultant, see what she says and take it from there. I would like to feel better.