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[CrispyChick]

So, when on HRT, do serum blood levels build up over time?

Or do levels reach 'a level' quite quickly and then the 3 month wait is waiting for your body to recognise, utilise and adjust?

Those that use private clinics, how long before they'd consider a blood serum test?

Thanks

[Dramy3]

Hey

The half life of most oestrodial preparations is pretty short and varies, but largely it lasts about 24 hours. Hence the patches deliver a relatively consistent dosage (25, 50, etc) over about 24 hours. Oestrogel is about 36 hours. But this means levels return to baseline after around 24-36 hours post dosing.

So long story short, no, the level doesn't build up--your body adjusts at a tissue level over time to the consistent flow of dosed oestrodial. If you stop that dosing, your blood level will drop within a few days, not gradually. Your tissues will slowly revert back as well and symptoms often return. This assumes post-meno though. If you are peri, then your own oestrogen will skew things.

The 3 month adjustment period is to allow the body to adjust so you know if your symptoms are relieved on that dose. Which is fine post-meno. But if you are peri, the 3 month window is a little more dubious. It will be enough time for your body to adjust, even with big fluctuations, but it's not great from a blood test point of view because one moment in time for someone whose levels are all over the place is kinda useless. I tested every 4-6 weeks when trying to find the right regimen for me. That way I had not only the symptoms to report at the end of the 3 months, but 3 blood tests to show an average level of oestrodial (it varied from 180-320 a few months ago).

That's a really long answer!

[Bungo]

So if increased  strength of patch and tested bloods a few days later,it should be reflected in serum levels ? Assuming are post menopause?

[CrispyChick]

Yeah, that's what I wanted to know bungo. Dramy3 mahes it sounds like that defo the case.

[CrispyChick]

But hold on. On re reading Dramy3 - u tested every 4-6 weeks and it varied quite a bit???

Was it genuine variation, or did the higher readings come towards the end of your three months???

Or are you saying you are peri?

[Dramy3]

Yep, you should see a level change within 2-3 days but personally I would give it at least a few weeks. And our metabolism varies during the day so it’s never an exact science. I try to do my gel application 4-6 hours before a test.

And yes, I’m peri so know my levels will fluctuate because the blood test doesn’t distinguish between my natural oestrogen and the HRT. That’s why I had variation and test multiple times to get a trend.


But remember that your blood level may not reflect how you feel. Your level may be great but if it’s early days and your tissues haven’t adjusted then you may still feel rubbish even though that level is right for you, your body just hasn’t caught up yet.

I guess if you are post meno and test after a week or so on HRT just to see if you are absorbing it, that could be helpful. But imagine any doctor is going to going to want you to give it at least 4-6 weeks before making a change.

[CrispyChick]

Thanks.

It's the opposite. My level is very low. And I'm still highly symptomatic with low E. But I'm also getting wildly fluctuating side affects, like mood swings. Which definitely suggest I've not stabilised.

I'm in chemical menopause so my E is zero. And I've seen that on tests. And it's also obvious what the HRT side affects are. 

I'm now at the 3 week mark. I just feel I'm flogging a dead horse if my E is so low on bloods. What will waiting 4-6 weeks prove? That is also what I was told to wait.  .

I was kinda hoping to be told it takes 4 weeks to build up to a decent level. My test was at the two week mark. This is patch.

Any help greatly appreciated. Xx

[bombsh3ll]

If you are on an estrogen patch and have had a blood test, there isn't much point waiting another few weeks at the same dose just to repeat the test.

It is reasonable to give SYMPTOMS a few weeks to settle and then review these with your clinician.

Blood tests aren't perfect and for multiple reasons a person on a fixed dose patch with no endogenous production could get variable test results, even if they tested twice on the same day. They are a useful tool to guide treatment but not the be all and end all.

Other than obviously feeling better, do you have a particular therapeutic goal for example a target level of estradiol? This could be for bone protection, or a particular level that you felt well with previously?

[CrispyChick]

Thanks bomb.

I've spoken to gynae now and I'm to increase dose. My low E symptoms are going nowhere.

No. I don't have a target. My main aim is stability, irrespective of levels. But I can't get stability going when my bones are dragging on the floor and I'm hot flushing waiting that all out.  And then that blood test.

I guess I was hoping for mid 200s as I know that's what I was on cerazette and I had no low E symptoms.

But, I dont really care about levels right now for other reasons. Very much the least of my worries.

I just want to be on a level where my low E symptoms subside, it shows adequately in bloods and then stick for stability.

I'm going to have a low threshold for going up now. Just get this trial over with. It's that or stopping the whole thing. I feel i've come this far...

[Seasidegirl]

When I started HRT Newson clinic told me to increase at 4 to 6 weeks if I was still symptomatic.   I think the 3 months is an NHS thing to reduce demand. 

Good luck

[CrispyChick]

Thanks seaside girl.

Yes, I'm with a private gynae and I was told 4-6 weeks. But I'm only at 3 weeks and it's now agreed I should increase. I'm pretty sure waiting one more week with a blood level of 72 is not going to help!

[AmandaJR]

I increased at the 3 week mark too with full backing from NHS GP. I remember her saying there was little point waiting for 90 days to pass with obvious E deficiency symptoms. I increased again not long after.
I so hope you get relief soon CrispyChick.

[CrispyChick]

Thanks Amanda. That's useful.

Did you get relief? What do you take now?

I'm struggling to see how I'll ever get sufficient if I only get 72 pmol from a 50mcg patch.