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[orrla]

Orrla,

That's heartbreaking and against the guidelines for effective treatment to be arbitrarily withdrawn based on age.

You can't continue to rely on the NHS having been let down like that, your health is too precious and the consequences of going untreated or under treated are irreversible.

I don't know about Newson but there are online clinics that will prescribe for you after you have a video consultation.

I can't do blood test online...

I need to my HRT up in an informed way, backed by science, with blood tests, so I do not damage myself even more.. Hence I searched for a Consultant with post menopause and HRT experience...  Shall see!

My body is fragile now. I don't want to start running around punching people either, or go back to anxieties... HRT are really powerful drugs, as we learned.. Wrong doses cause havoc!

[Uma17]

You haven't stated the units - if that estradiol is pg/ml that's quite respectable - but generally speaking in an untreated 69 year old both estradiol and testosterone levels will be in the toilet and there is little clinical utility in testing them.

I am not clear what you mean by a "proper" level - are you asking about treatment targets or just what a typical woman that age would have without any intervention?

Treatment is generally symptom based rather than focusing on specific blood levels, with the exception of ensuring testosterone doesn't get too high on treatment.

I do have personal thresholds for myself that I would not wish to be below, which are estradiol of 300pmol/L (cited by the late great professor studd as assuring bone protection) - both my parents have osteoporosis - and testosterone of around 2 nmol/ml based on probably having a touch of PCOS earlier in life and appreciating the athletic advantage and libido this conferred. I would not necessarily recommend this to others as treatment has to be individualised.

Hi Bombsh3ll

Do you have any research backing up this figure of 300 pmol/l as being the right level to protect sufficiently against osteoporosis? I know this figure is quoted widely but I haven't found any papers. Some years ago I did find a paper with research (trials) on oestrogen levels and one measurement - possibly bone turnover (can't remember now as it was 2011 when I read it), which suggested something like 165 pmol/ml was the minimum level, (if I'm remembering correctly) which is much lower. The licensed doses of HRT  are also only medium oestrogen doses so I have been curious about this but not spent time searching the literature. If you're familiar with the research ( apart from Studd's  recommendation) it would be really interesting to see it?

Hurdity x

Hi Hurdity

Form Chelsea and Westminster 250 pmol to protect against osteoporosis
https://www.chelwest.nhs.uk/professionals/gp-hrt-advice-guidance

My Menopause Centre has some references too on this page

https://www.mymenopausecentre.com/gp-resources/oestrogens-and-blood-testing/#fc-how-can-i-help-to-make-my-blood-tests-more-reliable

[Cassie]

Mary G thank you for clarifying that. I clearly need to up my dose a bit as my result came back at 88 pmol.

[bombsh3ll]

The late Professor John Studd is on record stating the 300pmol/L threshold as assuring bone protection.

I don't know if he published a study on this or it is based on his clinical experience, however his is the opinion which for me personally carries most weight.

I don't have the reference to hand but if you search this topic with his name it will come up.

There will of course be many women who maintain bone health with less but my interpretation is that this is the level that catches just about everyone, including those at higher risk - similar to standard progesterone doses, where many will be protected at a lower dose but some won't.

[orrla]

So, if one patch of Evorel Conti gave me 67, how many of them would I need to achieve 300?!

[orrla]

Am I reading this correctly?👇

'Older post menopausal women who need oestrogens for pelvic atrophy or established osteopenia or osteoporosis should initially have a very low dose possibly with unopposed oestrogens because the major side effects of the WHI study occur in older women receiving combined oestrogen and progestogen therapy'

https://www.studd.co.uk/hrt.php

(side effects: heart disease, stroke, blood clots, breast cancer, and dementia.)

Does it mean I should take more of Oestrogen only..?

There are those spray and gel, topping up that Evorel Conti would not be difficult..?

[Mary G]

Mary G thank you for clarifying that. I clearly need to up my dose a bit as my result came back at 88 pmol.

Cassie, that is exceptionally low considering you are using one pump of Oestrogel in fact it's even low for a post menopause woman not using HRT.

I would definitely increase the dose and then have another blood test to check the level in about three months.

I've noticed a lot of women on here are getting very low oestrogen readings with Oestrogel.  Has there been some kind of product switch in the UK?  I know you have problems getting hold of certain medication and I'm still filling prescriptions and posting from Spain to the UK.

[AngelaH]

Does it mean I should take more of Oestrogen only..

I would say you need the smallest dose of estradiol, which doesn’t require to be opposed with progesterone.

[Mary G]

Am I reading this correctly?👇

'Older post menopausal women who need oestrogens for pelvic atrophy or established osteopenia or osteoporosis should initially have a very low dose possibly with unopposed oestrogens because the major side effects of the WHI study occur in older women receiving combined oestrogen and progestogen therapy'

https://www.studd.co.uk/hrt.php

(side effects: heart disease, stroke, blood clots, breast cancer, and dementia.)

Does it mean I should take more of Oestrogen only..?

There are those spray and gel, topping up that Evorel Conti would not be difficult..?

That is an old paper from 2005 and should be completely disregarded and consigned to the dustbin of history because it makes reference to one of the two completely discredited studies that have no credibility whatsoever.

This is why you should never live and die by studies, they are often conflicting and they are often wrong as the two poorly conducted and deeply flawed HRT studies were.  One of them was aptly called the million women study because it ruined millions of women's lives - millions of women immediately stopped using HRT when they didn't need to.  Interestingly Kristy Wark stopped using HRT on the strength of those wretched studies and ended up with osteopenia.

Professor Studd later disregarded those appalling studies and everyone else should too.

[Mary G]

Does it mean I should take more of Oestrogen only..

I would say you need the smallest dose of estradiol, which doesn’t require to be opposed with progesterone.

Do you mean something like the Menostar that is used in the US? 

[orrla]

..so I said to my GP who wanted me off HRT in ca 2012, and asked where is that breast cancer I suppose to have and the reason she wanted me off..

Strangely, have quite few old friends who never took any but had breast cancer.

Yes, I know it.

But, where are more recent studies and reliable, safe, recommendations for post menopausal women..?!

These quoted above in this thread recommended by Studd 300 dose come from exactly same period!

How it is on too low dose I already know!

[orrla]

Does it mean I should take more of Oestrogen only..

I would say you need the smallest dose of estradiol, which doesn’t require to be opposed with progesterone.

Do you mean something like the Menostar that is used in the US?

Yeah, a seperate issue of what really is available and where!

[AngelaH]

Do you mean something like the Menostar that is used in the US?

You need to ask that Professor

Usually such a small doses of estrogen you can get from VA treatment products or bio identical products from abroad. Just  1 pump of Estrogel is big enough to be used with progesterone.

[orrla]

..And may I ask all those who wrote here that they achieve 250 or 300 pmol levels:

what are you on and at what age, please?

Thanks!

[bombsh3ll]

Orrla - check the units on your blood results.

There's a big difference between pg/ml and pmol/L.

I am 44 and on Zoely for menstrual suppression which is a combined oral contraceptive pill containing 1.5mg oral estradiol, and a suppressive dose of progestin. My estradiol level is around 390pmol/L.

However the pill doesn't shut your own estradiol production down to zero, and my estradiol when I previously tested on suppression without any exogenous estrogen added back (desogestrel 150mcg only) was around 100pmol/L.

Therefore I am getting roughly 290pmol/L from 1.5mg of oral estradiol.