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[Marchlove]

From personal experience I find that lower estrogen dosage is far better. Not easy to achieve, especially if you have been on a high dosage as the body needs time to adapt.
Low and slow if starting out and then again low and slow when reducing to find your sweet spot.
Yes unfortunately the symptoms high vs low are remarkably similar
but from what I’ve read, high can indicate adrenal insufficiency and low a cushing’s type syndrome, high insulin for instance.The two extremes for sure so it’s a question of balance.
This is something you have to feel through yourself, which is very difficult and takes time.
Sorry I haven’t put any scientific studies, I just speak from how it’s all playing out as far as I’m concerned which might hold some relevance for some. x

[Gilla999]

Marchlove I couldn't agree more. I made the mistake when first starting HRT/ Lenzetto to start on 2 sprays which I actually think in retrospect was too high at that point - not only did it cause a rapid stone in weight gain and terrible constipation but I then found it incredibly hard to reduce the dose once I was on it. Even doing it slowly I still struggled. Some people like myself seem to be incredibly sensitive to changes in Estrogen. So to any of my friends now I always recommend starting off with the minimum.

[Postmeno3]

Interesting, Marchlove, as I don't have high levels of oestrogen starting off with them at 60 (once ON HRT!)  which would be through the floor for anybody, whilst undoubtedly having quite marked adrenal insufficiency alongside and always have had for many, many years, only replacing hormones in the past year. I believe my "M.E" was indeed triggered by a total endocrinological/adrenal crash. So, it maybe doesn't always follow that high levels indicate adrenal insufficiency and is certainly not applicable to me. Just goes to show how incredibly unique we all are and how we can trick the theories. Soooooo interesting!

[Marchlove]

I think you’re probably right about what triggered your M.E.

My book ‘A practitioner’s Guide to Physiologic Bioidentical Hormone Balance’  on P102 which has a long list of low cortisol symptoms one of which is prolonged fatigue! Then says Symptoms  of Progesterone/estrogen dominance. Which I suppose would apply more to peri menopausal and when after you taken hrt for awhile.
It then goes in to say ‘Note- Symptoms of both high and low cortisol coexist under chronic stress and indicate adrenal dysfunction’.
In other-words they can fluctuate throughout the day, especially in the early stages.
Also says symptoms of hypothyroidism can exist in both high and low cortisol.
Good book, but it’s going to take me ages to figure it all out!! x
 

[Postmeno3]

Yeah, an awful lot will depend on stage of menopause and how long replacing or accumulating. I just like to go mostly by how I feel, though, as my presentation can't really be categorised. We're all so very unique as I think someone was writing about the other day. I'm a great one for throwing away rule books! Across all aspects of my life, they've rarely served! 😂

[Marchlove]

The book is written by an a renowned American pharmacist, Jim Paoletti, who has over 35 years experience of bhrt and is very respected in his field.

By my quoting from a small section of one page in the book it puts things totally out of context about what the book is about, which is basically balance.
He looks at every single aspect of the endocrine system and gives guidance on how all these things can be addressed.
Although it’s aimed at MD’s, nurses etc, it’s in a lot of respects an easy read if you are somewhat into the whole hrt issue and have researched to some degree yourself.  I’m fact I would say that a lot of the women o n this forum would have a clearer understanding upon reading this book than the vast majority of our GP’s!

[Gilla999]

Thanks for the recommendation Marchlove i'm going to give that I read - I am a huge advocate in ladies educating themselves on it all (primarily because so many GPs I've come across have been so useless on the topic!). I wish we'd learnt more about it at school! I agree with you completely too though Postmeno - my particular situation is also unusual in needing to start HRT at 42 whilst still regularly ovulating (I won't bore everyone with my story and the reasons why). That's why when people advise (either on the forum or unknowledgable GPs) that you "can't" need HRT while still regularly ovulating I always give an internal sigh and try to chime up with my two pence. Every woman is so different with their story and their needs.