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[pepperminty]

Hi Ladies,

I know we are all different but what are the ideal/ recommended/ average estrogen doses when on HRT

For example when we are below 45 years a high dosage of estrogen is recommended.

Is a medium dose ideal throughout the 50's.

After menopause are we supposed/ advised to reduce the estrogen dose, is this also advised when one is in the 60 age bracket.

I realise it is all symptom related, but there must be a rough guidline?


Peppermintyx

[GypsyRoseLee]

Hi PM. Lovely to see you.

I have been wondering exactly the same. I have been on 4 pumps for 3 years this June. But I am 50 next year and wondering whether to drop to 3 pumps then?

[Conolly]

Hello pepperminty and GypsyRoseLee,

This is a very interesting subject. I don't have the answer but I also would like to know if there are rough guidelines, as you say pepperminty. The average speech is to have the lowest dose possible that control symptoms, but in practice what we see is many ladies upping the dose to 4 or even 6 pumps of Oestrogel. I understand there's a wide spectrum of possible responses, so establishing ideal/recommended/average doses must be very difficult.

I also think there aren't many long-term studies regarding the transdermal route, so the guidelines can't be specific, but rough numbers would be very helpful, considering that not many GPs are up-to-date on menopause.

Other aspect to consider is that once optimal doses can be established age wise, the manufacturers would be forced to deliver more options, which I don't feel they are eager to do. Even the gel, that in theory is easier to adjust doses, would be necessary in different doses. I can't imagine using 6 pumps every day.

Conolly X

[Charlie62]

Hi pepperminty,

I would also like an answer to your question. I am wondering whether to reduce my everol conti patch by half. I am 56 so am probably post meno but probably won't know until i try to come off the hrt? Its all so confusing

[dangermouse]

I suspect the HRT is meant to mimic the under 45 age range regardless of current age. Naturally the oestrogen levels would be low and stay low once they'd settled (a few years after meno) so the other option is to stop the HRT when you can guess enough years have passed so you no longer have the fluctuations and oestrogen spikes and the symptoms may then only last a few months.

However, if you're taking a very high dose to suppress your own hormones then you could gradually drop to the normal post menopausal regimen a few years after you think periods would have stopped.

[pepperminty]

Hi GRL,

long time no speak! I must stop all these interesting questions, I don't know where they are coming from! I am sooo glad you have found a path that works! 

Yes, I know there is no ideal, but I have been on a relatively low dose, which was working ok. I tried increasing a few time and it didn't suit me.

Peppermintyx

[pepperminty]

Hi Conolly,

Yes we need more data on this.

Peppermintyx

[pepperminty]

Hi charlie62,

It is trial and error, maybe snip a bit off and see how you go. I am 52 and want to keep as I am until at least 60 if I can, then see how I feel. But what worries me is will I be able to manage without it? Is it easier to come off once you have definitely reached menopause?


Peppermintyx

[Hurdity]

Pepperminty - good question - but - how long is a piece of string?!

Firstly there are no standard oestrogen levels at any time throughout a woman's life - or rather there is a range of oestrogen levels which are normal and it is huge! Oestrogen levels follow a change and a pattern throughout the menstrual cycle and in pregnancy - but they are not the same for every woman and are enormously variable.

Secondly there is no correlation between absolute oestrogen levels and symptoms and mood - just general principles. The corollary of that is there can therefore be no standard oestrogen dose which can guarantee whether a woman's symptoms ( whichever they are) will be minimised or eliminated.

Thirdly there is high variation between oestrogen replacement dose and systemic oestrogen levels both between different women and in an individual woman with different modes of delivery - due to different absorption.

For osteoporosis prevention there is a guideline estradiol level but this is pretty low - so certain minimum doses are required to achieve this.

Those who suffer from reproductive depressions are also advised to have levels consistently much much higher than they would experience throughout their normal menstrual cycle.

The old mantra for HRT was the lowest possible effective dose for the shortest possible time - which has now been superseded by the advice that we can stay on it for ever and to take whatever dose is needed to control our symptoms (that is compatible with our general health and tolerability of side effects).

So there are all these factors to consider: dose of oestrogen, systemic levels of oestrogen after different doses, control of symptoms,  protection of health, and side effects.

Generally if you are under the natural average age of menopause - on average your oestrogen levels would be much higher than post-menopausally - whatever age you are when you reach menopause - so it makes sense to replace oestrogen at a higher level. I did read somewhere that the aim of HRT was to achieve oestrogen levels  that approximated to the average oestrogen levels over the menstrual cycle - but as I said before this is an average and levels vary hugely....therefore if I was under the average age (ie under 51/52) I would try to go for a higher level than the minimum needed to control eg hot flushes - just to make sure my body had what it should have had...

As we get older - and many of us will live 40 or more years post-menopause if we are lucky - we have to consider the disadvantages. For a start there have been no long term studies in older women and especialy for the transdermal and body-/bioidentical HRT regimes currently being prescribed more and more - but also the high oestrogen has to be balanced against the necessaity for higher doses of progestogen needed to protect the womb which involves either bleeding into your 70's if taken cyclically, or enduring progestogenic side effects from the higher doses needed to protect the endometrium - this I feel is likely to be the limiting factor for most women - as most women have their wombs.

I also wonder too about the effect of having very high oestrogen levels into your 60's and beyond - I'm not sure whether this is sustainable or desirable - but as I don't have such high levels I have no idea - and again it hasn't been studied.

As for taking 6 pumps - anyone who needs 6 pumps to achieve relatively average oestrogen levels is clearly not absorbing it and should ideally try a different method - patches or even tablets perhpas - or a combination. Women in surigcal menopause are a special case and general advice or principles do not apply in the same way.

The mian thing is - it is not a precise science and we are all individual!

Don't stop asking the questions pepperminty!

Hurdity x

PS I'm 65 and still taking HRT cyclically.... 62.5 mcg patch, testosterone blob, utrogestan on long cycle

[pepperminty]

Hi Hurdity,

There are many string lengths I see. Very clear explanation thanks.

So there are all these factors to consider: dose of oestrogen, systemic levels of oestrogen after different doses, control of symptoms,  protection of health, and side effects.

I wonder exactly how long one needs to take HRT to see any lasting benefits? Should one aim for mid 60's - so way past menopause and is that enough time to build up resistance on average? Or should one aim for continuation into older age - 70's and beyond on an ultra low dose to keep ticking on? When you stop does it all go south rapidly? Do we suddenly develope or indeed gradually develope all the side effects ( I don't mean flushes necessarily) but creaking and crumbling bones and a dickie ticker?

I would like to assume that as you wrote the smallest dose that controls the symptoms( various string lengths) tapering to a very small dose in ones 70's would be where I would like to be, baring any health issues etc. I am hoping by then as I am 52 years now tat there will be a little more information out there and a little more choice.

Peppermintyx

[Pinkjan4288]

Great question and some very interesting answers.

I've recently started bio identical HRT at 44 and feel so much better very quickly.

I apply 2 amounts of gel at night but when I stop taking the cyclical progesterone my breasts becomes so sensitive.
I'm assuming this is caused by Oestrogen dominance??
If I only use 1 squirt of gel I get hot again at night.

[Hurdity]

Hi again pepperminty - definitely that string again!  The general advice (see the Risks/Benefits info on this website: https://www.menopausematters.co.uk/balance.php is that the benefits of HRT exceed the risk until age approx 60 and that between 60 and 70 the risks can outweigh the benefits. There are benefits to continuing with oestrogen for as long as you take it - although as I said I wouldn't want to take a high dose in my 70's but yes ticking over somehow. As you age other factors come into play - although the risk info comes from that large study and using conjugated equine oestrogens and synthetic progestogens. There just isn't the info reagrding using body-identical HRT into your 70's as far as I know? As also explained on this website https://www.menopausematters.co.uk/risks.php the risks anyway are smaller than risks due to other lifestyle factors - notably being overweight, drinking more than the recommended daily allowance, having a sedentary lifestyle and poor diet - so the best we can do for ourselves is optimise these and then make the decision as to whether to continue with HRT - depending on other medical issues we may have. Re risks/benefits also look at the website of MyMenopauseDoctor (Lousie Newson).

You are still so young pepperminty - only just at the average age of menopause - many of us ( including me) had not started HRT at that age (I was nearly 54).

Hopefully there will be more info over the next few years!

Hurdity x

[GypsyRoseLee]

A useful post Hurdity, thank you. Prof Studd did stress to me that all women need different oestrogen levels to feel 'normal'. He mentioned that women who suffer with the reproductive depression/anxiety generally need levels of at least 800 p/mol and above.

When I first saw him my p/mol was only 294 (I think?) and I had been wearing a 50mg Estrodot for a few months  prior. So no wonder I was on my knees.

[pepperminty]

Hi Hurdity,

thanks for calling me young! I know that transdermal is recommended after a certain age. I am on tablet form at the moment.  Personally I would like to remain on HRT for as long as I can , as we are all living longer and I am not sure we are designed to live that long without estrogen.
 
I hope that starting HRT in my late 40's whilst in peri is a good thing in the long term.

Thankyou all for your interesting points.

Peppermintyx