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[Abc123]

Hi,

My GP kindly agreed to test my oestradial and testosterone levels because my fatigue has been awful since January. There could be other reasons for it but we decided to test to rule either too low a dose or not absorbing it properly.

I've seen on my GP app that my levels have been marked as normal but I was looking for some input please. I read on the Newsom Balance site that she likes levels of oestradial to be over 250 and some need it to be around 1000. https://www.balance-menopause.com/menopause-library/hrt-doses-explained/#:~:text=If%20you%20are%20having%20symptoms,to%20be%20over%20250pmol%2Fl.

My result is 147 pmol/L and the range for L luteal phase was 130-900 pmol/L and post menopause range is above 110 pmol/L.

When the test was agreed upon I'd not had a period for 9 months but typically had one 2 days after discussion. So had blood test on day 23 since first day of period.

History - Started HRT combined patches 2 years ago. Evorel sequi 50 combined with an extra 25mg oestrogen only. Sporadic periods, never been regular since starting HRT and were very sporadic 18 months prior.

Changed to oestrogel 2 pumps am and 1 pump pm and 200mg utrogestan initially orally in January due to skin reaction to patches.Changed to PV due to very low mood in February.

Also use Ovestin a minimum of 2x week but sometimes need 4x as bladder gets over sensitive on 2x week dosing.

Sorry for such a long post but I wanted to include all that may be relevant!

Can anyone advise if the lab ranges are correct for those on HRT/what level I should be looking for please? Thank you very much.

Edited to add that I only had one month of oestrogel, then it was changed to oestrodose.

[Wrensong]

Hi Abc123, very quickly your oestradiol @ 147 is quite low for someone on 3 pumps of gel, which is considered roughly equiv to 75mcg patch.  Absorption varies so much between individuals, as does what level we feel our best on, but if you are not yet postmenopause it seems likely you would feel better with higher levels.

I'm long postmenopause & my gynae (not Newson) advises to aim for 300-800, BUT some women will feel well with a lower average than this.

Testosterone can be the missing component for some women, especially where fatigue & stamina are concerned, so this could be worth pursuing with your GP once the result is in.  I expect your GP has run other tests to try to ascertain the reason for your fatigue, inc those for anaemia, thyroid, Vit D?

Wx

[Abc123]

Thank you very much for taking the time to reply and sharing with me the figures you were given.

I did have my testosterone measured and that was 0.56 nmol/L which I think is OK? But I'm not too sure.

I do have some other things going on, I have long covid, microvascular angina and borderline low B12. I've not had vit D tested for a couple of years and think it may also be low given how much my B12 fell in the past 12 months. So the GP and I were trying to tease out the big decline in fatigue and mood since January and rather than blindly waiting for B12 levels to come up on oral supplements, we decided to test hormones too as I feel so desperate.

I think I'm going to need to see a specialist to help with the hormones as I know good levels of oestrogen have been shown to be important in Microvascular Angina. Writing this I realise I just don't have the energy or fight to have to do the research to present to my GP to see about higher dose. I just want someone else to take control and see the big picture.

Thanks again for replying xx

[joziel]

Abc123, I hear you there. I gave up too and I'm with Newson Health who have me on 10 pumps of gel. My NHS GP is happy to prescribe it with the letter from my Newson doctor so at least I don't need to pay for the meds, just the appointments once a year. Well, it might need to be more than once a year as I probably need to go up from my 10 pumps... (10 pumps has me at 430pmol and I still have some night time symptoms.)

[Wrensong]

Hi Abc123, you do have a lot going on, I'm sorry to know that & I completely get your wanting someone else to take on the menopause issues for you.  I know the feeling, with several chronic conditions myself, but unfortunately find the combination seems too complex to expect many doctors to take an overview, especially those under great time pressure in NHS consultations & I have ended up pursuing much of it myself with various specialists for many years.   A good GP is so valuable & sounds like yours is looking out for you with the various tests 

I can't answer your testosterone query definitively, you'd need to know the ref range, but the lab I use gives theirs as 0.1-1.42.  Something to raise with a menopause specialist if that's on the cards for you.  I'm afraid I know nothing about HRT use wrt angina, another issue for a specialist I feel.

I hope you find a good Menopause Clinic to help you make progress.
Wx

[Abc123]

Thanks so much, both of you! I really appreciate the support, just writing it out helps.

I didn't sleep well last night so today I've been trying to get my head around things. After reading the thread on oeatrogel/oestradose, I have decided to initially ask my GP to move to Sandrena gel. My big increase in fatigue and depression onset coincides with the move to gel and oral then pv utrogestan. I thought the progesterone was the issue but there's no real difference between when I take P and when on my break which makes me think it's not that and is more likely the gel.

I found some info suggesting for bone health my level needs to be above 250 (I think, may have been 200). I have a family history of osteoporosis with fractures on my Mum's side, my Dad had it and my sister has osteopenia. As I'm inactive due to my issues, I know I need to safeguard my bone health as I have a lot of metalwork in my spine.

For hormonal depression levels of up to 400-600 pmol/L were suggested in this primary care guide: https://www.chelwest.nhs.uk/professionals/gp-hrt-advice-guidance

So while I do some research as to which specialist might help best (some microvascular angina folks have seen endocrinologists), whether that be a gynae, endocrine or menopause clinic specialist. It gives me a chance to get my oestradiol level up and speak with my cardiologist to see if he has someone he works with.

By the time all that happens, the sandrena may have improved things and if I at least get my levels of O up, I can then see if testosterone may be beneficial?

I'll update once I've had contact with the GP. Thanks so much and wishing you well xx

[Wrensong]

Having thought more about your situation overnight I'd logged on to ask whether you thought Utrogestan could be the culprit, but I see you've posted again & had already discounted this possibility.


Makes sense to have good levels of oestradiol with osteoporosis in the family & yes I've also seen 250+ mentioned as lowest for bone protection, though any systemic oestradiol supplementation should help to a degree.  I have osteopenia but have been getting v inconsistent serum oestradiol levels recently so this is a concern for me too.  Your last result is quite low as regards what's often advised for optimal symptom relief regardless of the bone issue, so if you can get the level up with approval/guidance from your specialists this seems a sensible aim to me.


Yes, it's usually advised to have reasonable levels of oestradiol before starting testosterone but I don't recall seeing "reasonable" quantified in this respect, so you may want to do a search on here to see what other women have been advised, or maybe start a new thread posing that question.  Of course if you decide to see a MS, you can be guided by them.  I would also mention to your cardiologist that you are thinking of trying some testosterone if you haven't run this by him/her already.

Do let us know how you get on & I hope you'll soon be feeling a lot better.
Wx

[Abc123]

Thanks very much for thinking of me Wrensong. It is possible still that it's the utrogestan but I'm not feeling better during the time I'm off it, so I don't think it's that although it may be playing a part.

Sorry to hear you have multiple things going on too. I totally agree, it's so hard for the overall picture to be seen. I know I'm also a bit of a control freak who likes to understand the minutiae, but when so fatigued I try to let that go. Then I realise I stress more not knowing, so take my time to try and get the understanding I need to then be able to advocate for myself.

My GP was fab this morning, totally agreed my I levels are too low so I'm trying Sandrena 1.5mg. She agreed I'm at risk of osteoporosis so we have a plan to supplement for that.

I forgot to ask will I need another blood test but I'll broach that in the future depending on how I feel. If I feel loads better then I won't worry about it. And if I do go on to see a MS, I guess they'll want tests redone anyhow.

Thanks again and wishing you all well xx

[Teresa]

Hi ABC123,

I’m sorry I’m a bit late to reading your post but I was in a similar position to you last year as my estradiol levels were 81 after being on HRT for 2 years. I was on a 75 mg patch and utrogestan. I then tried Estrogel but after a week had to give that up as I felt awful and go back to a patch.
GP admitted they didn’t know what to do, so I saw a private menopause specialist. She said she thought I was a poor absorber. I take medication too which is known to affect HRT, so I was at a complete loss. She suggested I tried Lenzetto, (3 sprays) which I did, she said this had worked well for others in a similar position. I also got a mirena coil fitted locally at a private hospital as I was also having intermittent bleeding, which utrogestan wasn’t solving.
I have to say, Lenzetto has been a lifesaver and I took to it straight away. I have since had a blood test (taken just before I sprayed Lenzetto that day) and my levels were 452. I’d been on Lenzetto for 3 months at that point. I know Lenzetto doesn’t work for everyone, but fortunately it did for me. I knew things had improved though within a week, as I was sleeping better and my anxiety improved so much. I feel so much better now, nearly a year on.
I’m not suggesting that being a poor absorber is your problem, but it could be a possibility, that might be worth considering and a different form of HRT, which you are doing with Sandrena, that might be the answer. If not, it might be worth trying Lenzetto?
I too have osteoporosis in my family -both my parents had it, so I’m keen to make this work for me too.
Good luck and I hope things improve for you.

[Abc123]

Thanks ever so much Teresa, I really appreciate you replying.

So pleased you feel better on Lenzetto and that your levels have come up. My partner collected my Sandrena today so I'm trying it tomorrow. I'm a bit nervous but also quite excited that it gives me hope of improvement when my levels do come up. I don't have stereotypical menopause symptoms, well maybe I do but it's all so entwined with Long covid and my angina that it's hard to navigate. I found out about poor absorbers via a long covid hormones video and that is what made me ask my GP for a test. Thankfully she's open to suggestions so did it with no issue.

Thanks again, it's good to know I have Lenzetto as another option too.

I'll keep the thread updated as to how the Sandrena goes, take care and it's great to hear positive experiences from similar situations.

[Teresa]

I’m glad you saw my reply Abc123,
Yes, please do update with how you get on. When I was on HRT for those first two years, I didn’t have any real menopausal symptoms that I knew of, apart from not sleeping and bad anxiety…I never had hot flushes for instance so thought it must be doing something and this was as good as it gets, but it obviously wasn’t doing anything at all. I’m sorry to hear you have other things going on too, which all adds to the mix, I know.
I’m glad too that you have got a good GP, as so many don’t have a clue with HRT.

Good luck and I hope you see some quick improvement. If it’s working, you should feel different within a very short time…