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[Blue Kingfisher]

I’ve been under two different clinics that use two different forms of testing. The one that uses blood tests says my oestrogen level is too low and the one that uses saliva says my oestrogen levels are too high.

My latest blood test shows my oestrogen is 105 (77-2400)

All I know is when I was on a higher level of oestrogen I had one good patch each month but on a lower dose I feel dreadful every day. This issue is complicated in that my thyroid medication has apparently been inadequate. I’m getting my thyroid dose changed but low thyroid symptoms will definitely have been playing in. Just wondered what people think about the different types of testing and also what you think of my oestrogen level? I’ve been on 2.5 pumps oestrogel daily for at least six months now.

Thanks for any responses.

[Marchlove]

Hi Blue Kingfisher

This article from zrt labs explains it.

https://www.zrtlab.com/sample-types/hormone-testing-for-different-supplementation-types/

I’d go by the saliva test as what I can’t get my head around with the blood spot testing is contamination of the fingers if you are applying topical without using some sort of applicator.

If anyone knows of such an applicator please let me know! X

[Blue Kingfisher]

Hi Marchlove,

My blood tests have always been done at a doctors surgery with a syringe blood draw, not a finger prick test. I guess looking at that link they suggest a finger prick test is more accurate which I haven’t done. I’d imagine most ladies go by the serum blood draw on this forum but I’m just guessing. I’d also imagine they are using these test results to alter their HRT dose. Doesn’t mean it’s the right thing to do but would be interested to hear what other people think. Ultimately I feel worse on a lower dose but it could solely be my thyroid. I am experiencing low oestrogen symptoms however such as flushing, night sweats, insomnia & anxiety. Ultimately I could try increasing by half a pump to see what happens over a period of time. Difficult to know what to do with such different opinions on testing!

[Marchlove]

Yes I expect most ladies will be going by serum testing which even the GP’s admit isn’t accurate.
I haven’t done blood spot testing because of the contamination issue which they don’t mention in the article, yet they do for troche/sublingual regarding saliva testing!

Yes could be thyroid related of course which estrogen impacts. x

[CLKD]

I doubt whether a saliva test shows anything at all ..........

Blood tests for hormone levels are reliably unreliable too.  My GPs 'go' on symptoms.  As hormone levels rise and fall regularly blood would have to be taken at exactly the 'right' time to determine where oestrogen etc. might be.

How do you feel?  When did you last have a full blood count, VitD level and thyroid function tests?

[Blue Kingfisher]

Hi CLKD,

I last had a full blood count about 3 weeks ago and all was fine apparently. I supplement vit D and my levels have been high rather than low. Full thyroid test done a while ago but getting another one soon once I’ve been on my new thyroid dose for 6 weeks.

I feel hot most of the time, fatigue, night sweats, flushing, low appetite, headaches, very low mood, jittery, brain fog.

I think I will try increasing the oestrogel by half a pump for a while and see if that helps.

[Blue Kingfisher]

Also, I’ve had no withdrawal bleed after stopping a high dose of progesterone (200mg for 21 days). I stopped the progesterone 2.5 weeks ago…….does this indicate low oestrogen I wonder? I was on two and a half pumps of oestrogel.

[Hurdity]

Hi Blue Kingfisher

I answered on your other thread about the lack of bleed.

I would ignore any results from saliva testing - which is not standardised and not carried out on NHS, so completely unreliable ( for oestrogen and progesterone etc) and go by the standard blood testing using blood drawn from a vein as carried out by your GP (or private doctor).

Having said that as CLKD says all blood tests are unreliable and variable and can only be a rough guide. Estradiol levels not only vary throughout the day (circadian rhythm) but from day to day, and also if you take hRT - will depend on when your last dose was and in the case of gel also which part of the body.

As CLFD also says best to go by symptoms, and in addition if you have underactive thyroid then this too will be having an effect - important to get this right first and then tweak your oestrogen dose. Any change in dose should be done gradually either increasing or reducing.

What symptoms do you still have that you feel are due to incorrect oestrogen dose? Sorry I can't remember if you are  peri or postmeno and how old you are!

Hurdity x

[Marchlove]

Just because saliva testing is not standardised or carried out by the nhs does not mean it’s completely unreliable.

I expect the reason it is not carried out by the nhs us because it is more expensive and because they do not know how to interpret the results.

It begs the question what is the point of having standard blood tests if these are unreliable also, is this then a waste of nhs resources?!

[CLKD]

Marchlove: as I stated above, hormone levels alter throughout 24/7, so to take a blood test it would need to be carried out at 'exactly' the correct time .  If saliva tests were reliable they would be available on the NHS.  I wonder which hormones are present in a 'spit test'?

Blue Kingfisher: you seem to be on top of your various tests, hopefully the thyroid function will come back within normal limits: however, this does not mean that the thyroid isn't 'upset'.  Many GPs however won't request further testing even when patients complain of continuing symptoms relating to the thyroid.

Let us know how you get on with upping the dose, mayB every 3rd night initially?

[ATB]

I’m sorry but just because NHS doesn’t use it doesn’t mean it isn’t valid! Plenty of private doctors and labs use saliva testing for hormones. The NHS is completely hopeless with hormone issues so I wouldn’t use them as the benchmark, they are miles behind on thyroid issues.
I wouldn’t rely too much on testing if levels anyway, it’s something to use alongside symptoms which are a much better indicator.
Do not do blood prick when on HRT though. It’s contaminated by the creams etc on your hands, you need a blood draw or saliva but I have only used saliva for cortisol testing.

I would get your thyroid right first, then address your estrogen needs. I’m hypothyroid too.

[Blue Kingfisher]

Thank you everyone, I think we are all agreed that testing is unreliable and best to go by symptoms but for me I will be using blood tests by a doc as my ‘guide’. This is probably the best solution for me personally since I’ve kept a record over the years of my blood test results and how many pumps of oestrogel I was on at the time & I know how I felt at that time.

Thank you for the well wishes with my thyroid and yes, I’m trying to get that sorted as a priority but feeling now more confident that my oestrogen is currently a bit low. I’ll try upping by half a pump (maybe not every day) & see how I go.

Hurdity I’m 53, no idea if I’m not longer peri as I’ve been on HRT for a while now 

[Gilla999]

Read this thread with interest! I have found testing of my Estrogen to be absolutely critical in my meno journey as an indicator of where things are. I've always used venous tests from Medi checks and found the results to be very reliable. Never been convinced of the notion of your Estrogen level fluctuating massively during the day - doesn't fit with all the publications of how your hormones fluctuate regularly in a cycle and certainly hasn't been the case for me. I often wonder if that's a myth peddled by the NHS who don't want to do blood tests! You do have to test on roughly the same day in a cycle if you're still having one, in order to get a good comparison, but doing it that way has worked very well and very reliably for me.

Does anyone here know of somewhere you can compare the results from salvia tests to blood tests? I had two sets of salvia tests done back in 2018 pre Peri and I would desperately love to know what the equivalent results are in pmol blood test, but despite searching everywhere I can't seem to find a way to get a rough idea of comparison!

[Marchlove]

Gilla99 - You might find something in the footnotes of this article, but I haven’t read them to see x

[Gilla999]

Thanks Marchlove - I did have a good read (and googled till I'm blue in the face!) but can't seem to find an equivalent given anywhere.

I've had saliva, venous and finger prick blood tests done and never had a problem with reliability on any of them - the salvia rhythm tests (also DUTCH tests) were extremely useful as are the blood tests I have done, which have never fluctuated much outside of the normal pattern of your cycle, with thr exception of once when my estrogen plummeted and I needed to up my dose (the blood test confirmed why I was feeling so terrible). Blood tests have been so helpful for me, I'd be shooting in the dark without them


The only reliability problems I've ever had was from using a finger prick test once I started on HRT - even after wearing gloves for 2 weeks to put on Lenzetto (and you don't even touch the product like you do gel) I got a contaminated reading every time. So gave up with those in the end and stick to venous!