Hi - sorry to hear you are feeling grotty (and worried).
I've been battling with wildly fluctuating levels - this isn't about me - but what I've now learned, from a proper leading meno consultant includes ...
- Perhaps more common than when you're 50 or 40 or 30, but there's no certain age when we get post-menopausal, so I'd not rely on that!
- as Reb says, it's worth knowing what day you tested (both 2000 and 158) - plenty people have a drop on day 4 or even day 3 / surge on day 1. If it's patches, it's unlikely to have contaminated the test in another way.
- if your levels are that high (well over 1000) there could be tachyphylaxis, which basically floods the receptors and therefore you feel grotty again. I was in way more trouble on very high than very low levels - it also exacerbates any peaks/troughs/crashes you might have from own estrogen or any inconsistent absorption 'cos the peaks are higher so drops are bigger - and I've been very ill indeed - apart from sore boobs, not the 'typical' too high oestrogen symptoms but terrifyingly grotty and unable to cope. I had been put on very high patches and when finally saw proper leading consultant he said the level probably built up over time (but because I had weird absorption going on this hadn't been obvious as my levels were so swingeing).
- So yes you probably do want / need to get it down if that's a true reading but fwiw it might be worth having another test on day 1 of patch (ideally about 12 hours after change) to be sure it's a true reading, and then doing further tests at that same time.
- Depending on that, when you say 'increments over the next couple of weeks', fwiw maybe don't rush down. Your body needs a bit of time on each level to adjust and for you to know what's going on. If you have that 2000+ level confirmed you could perhaps try 75 but then perhaps stay there for a good few weeks to see how you feel and if it's better get another blood test there before you decrease again?
- I'm surprised meno consultant said aim for 200 ... most say 400-600 (I think I've read here that 300 is min for osteo protection?) and that some women need a bit higher (600-800). Could you get a referral to another meno consultant? Waiting lists massive but a co-operative GP should see a level over 2000 as a priority and at least then you'd be on the way / list ...
But obvs I'm not a doctor, just sending you hugs and empathy.
Are your scans up to date and have you been taking higher progesterone, which is also important at higher doses?
Hth x