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[Teresa]

Hi All,

I am in a bit of a predicament and I hope someone can help as I’m just at a loss as to what to do for the best. I’m post menopausal and have been on conti HRT for nearly 2 years. Two weeks ago I had a mirena coil fitted ( it’s my third, but first on HRT) due to post menopausal bleeding, which has been going in and off for over a year. I was on utrogestan orally.

I know I don’t absorb Estrogen very well. Just over a year ago, I had an estradiol test after being on Evorel 50 for a few months and the result was 106 pm0/L which I knew I was low and that was a low reading. Since that time, I’ve been on 75 mcg and haven’t really felt any different. I don’t suffer from hot flushes but I do get a lot of anxiety and insomnia.

I have just had another estradiol test done and the result is even lower at 88 pmo/L  so just to clarify, this is on 75 mcg Evorel which I’ve been on for the past 18 months.

I have tried Estradot which I didn’t feel great on at all and recently I tried estrogel ( on the advice of the gynae) but I could only cope with that for two days as my anxiety went through the roof and I just did not sleep at all. (That was three weeks ago and could be the reason for the dip in the pmo/L reading as I think my levels really took a downward turn when I tried the Estrogel)
I do have estraderm 100 patches from the private clinic, but only because they didn’t have Evorel in stock. I’ve read that they don’t stick very well, so I haven’t tried them, as I’m used to Evorel sticking perfectly, so I’m waiting to see my GP about upping my prescription instead

I take a medication which is known to affect HRT and I think this is part of the problem, it’s convincing others now that I need to increase to a lot higher. I saw a private gynaecologist recently for HRT advice, who also fitted the mirena & who told me not to take notice of blood tests and to ‘go on how I feel’. After telling her I don’t feel great still, she upped my patch to 100 Mcg. She also prescribed me testosterone as that is low, but I read you can only take that if your are ‘fully estrogenised’ so I’d been holding back until the blood test result ( and glad I did).
I haven’t yet seen my GP to increase my prescription to 100 Mcg based on her advice, but now I’m thinking I probably need to increase it to 150 Mcg at least ( probably more). There’s really no point me being on HRT if I am not getting the benefit of Estrogen to protect my bone health and my mental health, but I’m wondering now, how I can convince my GP I need to go even higher?

Has anyone increased to 150 Mcg or higher, whilst being in a mirena coil, due to absorption issues? Is it safe to do so?

Thankyou,

Teresa

[CLKD]

Firstly - the gynaecologist should have sent a letter to your GP so any new prescription is with the Surgery.

How up2date is the gynae about peri menopause?  Hormonal blood tests are reliably un-reliable. 

There are certain restrictions on to how large a dose can be prescribed of any medication.  2 weeks isn't long enough for the body to have adjusted.  If U have 'read'  the non-stick scenario may not be a problem for you.  U do seem to be consulting a lot of medical professionals without any joined up advice?

Your GP may not be OK about prescribing if you have been seen privately.  You may not 'be able to convince your GP' - if a medication is prescribed up to a certain dose then not many, unless a dedicated menopause clinic, are likely to prescribe over and above. 

Keeping a mood/food/symptom diary may be of use ....... HRT isn't a cure for many.

[Flossieteacake]

If you find the Estraderm do not stick well then you can use a Tedaderm dressing to put over them. Patches will not stick to my skin and I just pop a Tegaderm over them and they stick fine.

I think it would be worth trying the 100 patch to see how you feel. As for using 150, this is possible and a menopause clinic would prescribe this for you. The GP will not usually prescribe more then 100 but you could ask them to refer you to an NHS menopause clinic who will.

It is horrible you are struggling to absorb oestrogen and I can understand why it is getting you down. I remember reading of a member on here who had an oestrogen implant and felt better on that but I do not know if that is an option for you.

[Teresa]

Hi CLKD,

Thanks for coming back. I am post menopausal and have been for a few years. I’m pretty certain I am that low level of Estrogen unfortunately as this other medication that I take is known to affect HRT. It’s quite a toxic medication and has affected other things which I’ve had to adjust, but I’ve been on it many years and cannot change it.

It was the GP strangely enough who asked me if I could go private for menopausal help, ( it’s the closest I could get to a private menopausal clinic as there aren’t any around here) so that’s why I had to seek other help. I’d lost faith in my surgery when the Nurse abd the only female GP couldn’t find my cervix ( as it’s tilted) to do a smear, so I had to be referred to hospital. My GP said that he would prescribe anything the private gynae would advise, purely because he didn’t know what to do about my bleeding at that time. The private gynae sent me the letter and the copy for my GP…as she was fed up with surgeries saying that letters get lost, so I have the GP letter as well 

The Gynae that I saw privately was an expert on the menopause. That’s why I chose her. She didn’t do my blood test for my estradiol leveks though ( I asked my GP for that). I know peri menopausal tests aren’t reliable, but post menopause ones are more reliable, I think?

I was always a bit dubious about trying another patch to be honest as I’ve been used to Evorel.

I may not have been clear about medication or two weeks. I have remained in 75 mcg of my patch throughout, only changing to Estrogel for two days, so my Estrogen levels may have dipped in those two day, but have been back on the 75 mcg for well over two weeks now. That’s what I meant, but I might not have explained it properly, I think based on the fact they were 106 after a few months on the 50, I’m pretty sure they’d still be low. It’s why I had the test again really, to satisfy my own curiosity.

I will just have to try and see if I can convince him to let me try 125 or 150 of the patch, rather than 100. I know HRT doesn’t fix all, but I’d like it to fix more than it is. I just want to have the benefit of taking HRT as it’s not doing what it’s supposed to otherwise. My estradiol levels are that of a post menopausal woman. I wondered if there were many others on a higher dose, successfully with the consent of their GP.
 
Thankyou for coming back, I do appreciate it.

Teresa
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[Teresa]

Thanks Flossie,

I will give the Estraderm a go as it might be a while before I get to see a GP. I haven’t heard of tegarderm but will Google it, Thankyou 😊

I know the NHS waiting list for  the menopause clinic is long, (up to a year where I am) another reason I had to go private,  so I might have to private again for help in increasing.

The implant sounds interesting - if all else fails, I must remember that 

Thankyou,
Teresa
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[CLKD]

U seem to B getting support and good advice from the practitioners.  It might be worth while considering an increase in dose a few times a week rather than every night initially.  Let us know how you get on.

[Teresa]

Thanks CLKD,

I am due my next patch change tomorrow evening, so I’ll change to the MX100 Estraderm that I’ve got ( Shane to ignore them based on reviews) they may be my saviour, you never know and I won’t know until I try them. I’m not sure what you mean about the increase in oestrogen a few times a week, as the patch provides the same amount of Estrogen daily and is changed twice weekly. I’ll up it tomorrow and see how I get on 😊 I’ll try and remain optimistic….
Thankyou,
Teresa
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[CLKD]

Sometimes altering dosage of HRT can cause difficult symptoms so advice is not to apply every night to allow the body to adjust.  Clear as mud 

[joziel]

Teresa, when you tried the Oestrogel and your anxiety went through the roof and you didn't sleep, what dosage was that?

Here's what went on for me...

I was feeling absolutely not much at all from a 62.6 patch. I got bloods done and my estrogen was only 198pmol. Rather than just keep increasing patches, we decided to try the gel - in case there was an absorbing issue going on...

They started me back on 1 pump of gel (not on 2 pumps or more - they didn't try to equal my previous dose). And I noticed a significant impact just from that 1 pump, compared to patches - more than a 62.5 patch. After about 10 days I increased to 1.5 pumps and after another week to 2 pumps.... (doing it quite rapidly as my symptoms are v bad but it will now be 4-6 weeks between further increases).

The point being: The side effects of high and low estrogen are actually very similar. When I first started HRT, I had far too high a dose and it made me lie awake in bed all night with heart palps, shaking.

So - if, when you tried the Oestrogel, you were started on 2 or 3 pumps, that might actually have been too high if you were able to absorb it much better than patches. Regardless of what patches you are sticking on yourself, your body isn't used to high estrogen because your bloods show v low estrogen. You might just have jumped in too high, maybe...? You could try again starting with just 1 pump.... ?

[Teresa]

Hi Joziel,
Thanks for coming back and it’s really interesting to read your reply.
I tried three pumps of the estrogel - so the equivalent to 75 mcg. I put it on my inner thighs. I wasn’t sure where to put the third pump to be honest, I read the leaflet a few times and it said to apply the third pump on top of the other two so I applied it over the 2 pumps on my inner thighs… but yes, 75 mcg.
My blood test was just over two weeks later, when I’d been back on my evorel 75 patch for just over two weeks. I did feel better as soon as I went back on the patch.

I was initially on 25 mcg Evorel, a long time ago and quickly jumped to 50 for 3 months, then up to 75, 18 months ago. It’s the insomnia and anxiety that I am concerned about the most and if I was to reduce my dose of estrogen,  I’d really worry it would get even worse?  I have very low testosterone too and have gel for that, but can’t apply it yet, as my estrogen is so low 

I hear you though, I’m just not sure I have enough courage to try a lower dose of estrogel.

It doesn’t help the confusion in that my estradiol result after 3 months on the 50 was 106 pmo/L and that 18 months after on the 75 patch, it’s lower at 88 pmo/L. I can only imagine it’s my natural depletion of estrogen that has also taken place this past 18 months perhaps. I’d be actually quite happy with your estradiol result!

I’m just at a loss. I don’t know where to go from here. No NHS dr, not even the private Gymae that I saw ( who is also NHS) I doubt will know what to do, or increase the patch further. I am convinced it’s my other medication ( carbemazepine) that is reducing my absorption.

I applied the Estraderm 100 this morning… I only got 4 hours sleep last night, (my insomnia is always worse when I have to sleep for a fourth night on the patch each week)
Thank you for coming back and trying to help me  hope I didn’t blather on too much, I’m probably a bit delirious 

[Teresa]

Hi CKLD,
Thanks for coming back earlier  and explaining about increasing the dose. It’s a bit tricky to do that when increasing the patch, as it stays on for half the week, but I see what you mean 

I’ve increased to 100 and we shall see how I feel on this…

Thank you
Teresa

[Teresa]

One thing I need to add, that I’m still very curious about us that during my hysteroscopy, my endometrial lining was atrophic ( very, very thin). I’ve never had a thick lining. I do wonder if this is also due to low estrogen, though when I saw the gynae, my only option fir progesterone was to have a Mirena, to take 10 mg provera daily, ( a very high dose) or insert 200 mg utrogestan daily vaginally. I wasn’t prepared to do Provera at such a high dose, or insert that amount of utrogestan daily (I couldn’t tolerate 200 orally daily) so I opted for the Mirena….I still cannot understand why I was asked  to take such a high amount of progesterone if my estrogen is so low. I did ask and was told it was to protect the lining, but I cannot help but wonder if my low estrogen is what caused my bleeding.

[sheila99]

It's possible to bleed because the lining is too thin. If you're taking a high dose of progesterone and not absorbing oestrogen you might well expect a thin lining. I would replace the patch every 3.5 days, some people feel they need to change every 3 days. I don't know about any implications because of your other meds but normally taking a high dose isn't dangerous because the important thing is what's in your bloodstream not what's on your skin. If your gp will prescribe more I would take it and if the nhs won't do a blood test get it done privately (medichecks does it, there are others). The blood test might be useful in justifying a further increase. If you still don't absorb I would try oral or an implant.

[Teresa]

Hi Sheila,

Thankyou so much. I did wonder if it would be that. Do you mean get another blood test in a couple of weeks or so, now I’m on the 100 and a different patch? See if it’s still very low? I think my GP would do that for me as he did the recent one. He even did a testosterone test for me a while back and i heard they don’t usually. I think I’m better off getting a blood test done via the GP….I tried getting one of those ones in the post and I can’t stab my finger 😬 I’m a bit of a wuss!

I asked the private gynae I saw recently about changing my patch every three days and she said she couldn’t prescribe more patches for me as I’d be going against the ‘norm’. I’m not confident in her upping my dose, but perhaps if I tell her what my latest estradiol reading is, she may change her mind. I am seeing her Monday now to ‘check my strings’ on the mirena coil. It’s been in two weeks and I couldn’t feel them earlier, but I think it’s me, doing it wrong. I couldn’t get an appointment with the Nurse at my surgery to check them for another fortnight so thought I’d better not leave it that long, if it’s migrated ( hopefully not).

Thanks again.
Teresa
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[joziel]

Teresa, how are you doing? I hadn't read your replies before but have now...

Doctors need to look at blood results if you are on the maximum licensed dose (100 patch or 4 pumps of gel) and still symptomatic. If your bloods come back low, then you are definitely a poor absorber and need higher unlicenced doses.

This has just happened to me actually. I was on 4 pumps of gel and my bloods showed 283pmol of estrogen (day 16 of cycle, so some of that was also mine). My Newson dr told me to go up to 5 pumps, which I'm now on for about a week and doing well. I might need to go higher...

But regular GPs get their pants in a twist about going above licenced amounts. IMO your choice is either to ask for referral to an NHS menopause clinic and wait ages and ages for them to approve the higher dose - or go private with a clinic like Newson and get them to prescribe the higher amount and get you sorted on something that works. Then when you are stable, they can write back to your GP and your GP SHOULD feel comfortable taking over that prescription even tho higher than the licenced dose.