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[laszla]

I recently switched from oestrogel (three years on 2 pumps, followed by three months on 3-3.5 pumps) to Estradot 100. This was at the suggestion of the consultant at Chelsea and Westminter.

My serum estradiol was far too low,  it did increase in the three months of 3.5 pumps but not nearly enough - I was advised it should be 400-800 pmol for my worst symptom which is anxiety and on estrogel it never even reached 300.

Cut to last two months on Estradot which I felt optimistic about but after a few weeks I felt worse than ever, very dark thoughts, unbearable anxiety. As I'm not due for follow-up til June I arranged my own blood tests and my oestradiol has plummeted by about 100pmol to well under 200.

I also continue to take testogel a few times a week but am absorbing very little (my SHBG remains high).
Utrogestan for 10 days. Although the progesterone phase is not my favourite, I manage it with agnus castus and this crippling anxiety can't be attributed to it because it occurs also in different phases of the month and I think can be safely attributed to low estradiol

I switched back to oestrogel today but even if I increase to 4 pumps which I was told I can, I can't imagine an additional half pump compared to what I was on in March will be nearly enough to get well over 400 and up to 800.
Is it unheard of to take more than 4 pumps (and good luck getting that many containers of estrogel in the current climate)?

I can't take oral so what options do I have - implants? (haven't managed to find out that much on them on the site)

[Dotty]

Hi 4 pumps is the licensed dose but you can be prescribed more by a specialist . I have seen posts about ladies being on up to 10 pumps a day. xx

[Sazzle42115]

Hiya I'm in exactly the same boat. Post Meno since 2016. On 4 pumps of gel levels 89. Switched up to 6 sprays of Lenzetto and dropped to 79. Have got to 130 but still really bad symptoms insomnia low mood anxiety. I'm due for implant in 2 weeks it really is my last option. Started antidepressant which has made me worse. You could go up in pumps it's not unheard of.

[3isenough]

Where did you get the implant in the UK?

[Nas]

Hi,
Sorry you are still struggling.
Why can’t you take oral ? You may absorb it better? Plus the progesterone in a particular type (femeston) is quite gentle.

Doesn’t sound like you are absorbing the gel? If you needed to increase to over 4 pumps, it would be tough to find enough skin to apply it, I’m sure? You could split the dose I guess.

Could you use a patch and a couple of dollops of gel? Some women find relief on that combination. What about the evorel patches? Or adding in an extra 25/50 to the 100 Estradot?

At this end of the day, HRT isn’t an exact science and we have to do what ever is necessary to feel well. If that means using a couple of products, then so be it.

Good luck.
It’s such an a tough time of life.

[Sazzle42115]

Private menopause clinic

[laszla]

Thanks ladies for your feedback, good to know that one can increase above 4 pumps - though as you say Nas, where is it all going to go on my skin - particularly when I've had a significant unexplained weight loss so not much real estate on my body!
I also wouldn't mind using two products and hadn't considered this - anything that raises my E2 I will consider.
I'll look into that option
Oral is not good for me because as it is my SHBG is high which in turn makes my absorption of hormones poor (especially relevant to testosterone but also estrogen).
So oral would compound the problem (I did anyway try Femoston as my first HRT before I even had a clue what SHBG etc was and it did give me some nausea).
Evorel I would rather avoid as I prefer to take body identical progesterone.
If mixing/increasing products doesn't work I guess only option will be implant that they did tell me at Chelsea was an option as a last report.

[Marchlove]

Hi laszla

I think you might have to look beyond your sex hormones for the reason of your continuing anxiety and focusing solely on what your levels might be in a snapshot of time.
Less can be more with estrogen as high levels impact our adrenals and thyroid which can both cause anxiety when dysfunctional.
Might be worth looking at having a full thyroid and saliva cortisol test just to see if they might be a cause of your ongoing anxiety.
X

[laszla]

Hi Marchlove,
high levels of estrogen might impact adrenals but one thing is certain and that is that I don't have high levels, however much I might apply to my skin, my plasma levels have always been low, rose slightly on increased estrogel and then dipped significantly on Estradot.
An even more tangible indication that my estrogen is too low is that I have developed osteopenia, despite doing resistence training, weights etc. That is another factor that doesn't help with anxiety and reason enough to increase my estrogen absorption as a matter or urgency - as also advised by Panay who recommends levels 400-800.
I have had thyroid, cortisol, ferritin, vitamin D and B tested and all are fine/optimal.
I know that many consider the NHS thyroid testing inadequate as it doesnt include thyroid antibodies and free T3 so I might test those additionally privately and possibly do the 4 point cortisol test but whatever the findings are I still urgently need more serum estradiol and testosterone.
x

[Nas]

If you are aiming for between levels of  400-600, then you are definitely going to need to increase your Oestrogen somehow.

It might be that you need gel and patch to get them up? Or gel and spray?

With a 75 patch, I can reach 465, but no more. With a 100, I’m a jittery tearful wreck. It’s such a fine balance to get it right. Even at 465, my sleep is poor and anxiety isn’t far away, but much better than with no patch.

What about 4 pumps and a 25 patch?

[Marchlove]

This is interesting, see section 5.2 Absorption, Distribution and Elimination.

https://emc-prod-ukwest-wa.azurewebsites.net/emc/product/3869/smpc

I remember from another thread that you stop hrt 24 hours before testing, so might this be having some effect on your levels when on patches?

[Winter]

I'm very similar to you - I was on gel (4 pumps) doing 'ok,' switched to Estradot 100 and boom, I felt immediately awful and had huge crash. Stuck it for two weeks, but felt worse and worse. I've been back on gel for two weeks, but not feeling better yet - doc said it may take a month to settle back on. Great. No high E symptoms like sore boobs, or headaches. She will test in a another 2 weeks and look at FAI too.

I believe from her you can be tested for E at any time of month, when on HRT (my cycle has gone a bit haywire)

[laszla]

Thanks Nas for the 'mix and match' suggestions which I will definitely look into asap and probably my choice will be partly determined by which products are harder to score in the current shortage debacle - I will need to go and quiz my farmacist.
I have read of people on here even on 2 x 100 patches! I hope you can increase your 475 though I must say I envy you being that high!

Marchlove, I couldnt open the link but will try to find that article, thanks. You're quite right that normally you are supposed to stop the HRT 24 hrs before testing and while I did this for my February test (when on estrogel), for my test last week I decided not to remove my patch precisely because I wanted to know what my levels were in a real life scenario, ie. not a day without HRT! And still it had plummeted...

Winter interesting to hear you had a similar experience, do you have an NHS GP that tests you that regularly and even includes FAI ? And if you are only feeling 'ok' with 4 pumps gel will you look into increasing?
True that if you are solely dependent on HRT for your hormones then it's fine to test any day.

[SueLW]

I have used a combo of 100 patch and sprays of Lenzetto.  I have also used a combo of Lenzetto and Sandrena gel.  My problem is that I need the higher levels of E. I don't absorb it very well, but I swell up when I start to get better dosing.  My fluid retention is terrible.

But those combos are well worth trying. 

I about to combo Lenzetto and a new combined pill to see if I absorb the E better from a tablet, but it's only 1mg so the doctor suggested I use it alongside the Lenzetto and as I already take Utrogestan the fact that this new tablet contains the Utrogestan inside it means I just need 1 tablet.

[Winter]

Hi again,

I don't have a GP who tests regularly - but sometime see a private GP who will and am asking my NHS GP next week if they'll do it. They did it last March and my results were testosterone - 0.4 nmol/l (which sounds low?) FAI 1.5 - which doesn't sound too bad?

If my oestrogen is low - I will definitely look into increasing - they didn't test it last March, last one was Nov 2020 and it was 329 pmol, and that's before I started HRT. Funnily enough before that in 2007 it was 309 - even lower! Not that either reading is particularly low - but maybe not optimal for me either.