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[Hopeful2]

Hi ladies.

I'm looking for some advise please ☺.

My hot flushes have got a lot worse over the last few weeks. But when I had a blood test about 6 months ago my level was 945pmol. I'm on Sandrena 1mg and utrogestan. As my last result was high could I ask to up my Sandrena by 0.5. My face is burning up as I type this. Thanks for all your help x

[bombsh3ll]

Your own hormones are likely to be fluctuating a lot in the background. You may have just ovulated when that last blood test was taken, so blood tests for estradiol aren't that helpful in perimenopause.

It is reasonable to try a dose increase if your symptoms aren't controlled.

Also gel can give quite unstable levels as it peaks quickly then drops. You could try dividing your daily dose and applying half in the morning half at night, or try a patch instead (if you can keep them on).

[sheila99]

A lot could have happened to your own supply in 6 months and imo the flushes would indicate you need a higher dose. If you get tested again best to do it when you've just started a bleed, that way your own supply is minimal and you can see what you're getting from the gel. At 945 it's likely some was your own.

[Hopeful2]

Thank you both very much for your replies 💐.

My periods are very irregular nothing for months and then over last few weeks very light bleeding/brown every 2/3 weeks I wonder would this be caused by low oestrogen too?

[joziel]

Yes, light bleeding can be too low estrogen.

These things are not very level dependent at all. The only reason to test estradiol is to be sure you are not getting stupidly high in an ongoing/permanent way and to see if you are able to absorb increases in dose. Even with those agendas it's a bit of a crap shoot and you might have to run several tests and look at the average of what is going on before you draw any conclusions.

You can ask to increase estrogen, for sure. If this is questioned you can do repeat bloods again. If you can schedule that for one of these light bleeds, that might give you a better indication of things... although hard to plan too far in advance. But if you schedule it as soon as you see blood and can get a test in within a few days, it might be possible.

[Hopeful2]

Thank you for your kind reply Joziel 💐.

I was a bit worried about upping it as last time oestrogen was 945pmol, but that was about 6 months ago. If I went up to 1.5 Sandrena would I need more progesterone? My progesterone last time was 25.7 nmol/L. Have no idea if that's good/bad?  Really appreciate your reply ☺

[joziel]

Are you in the UK? I'm assuming so as you're measuring in pmol...

We can't accurately measure progesterone, here. We can only measure progesterone accurately in women not taking oral progesterone. This is because the test we use inaccurately identifies all these progesterone metabolites as 'progesterone' and so it comes back wrongly high.

The test we need is the LC MS P test, which isn't available on the NHS. I haven't found somewhere privately that does it either, although there might be.

Really, we can only go by symptoms. If we get unscheduled bleeding or other symptoms which might suggest low progesterone, we can increase. And if we increase our estrogen and want to be extra protected, yes, we can increase progesterone. There's nothing to lose from increasing it, if you don't get the progesterone side effects some women complain about.

I really really really x20 doubt that you are getting an estrogen level of 945pmol from 1mg of Sandrena. That is the equivalent of 2 pumps of gel. You would need to be an amazing absorber of estrogen to be getting that much. I've never heard of it. What is WAAAAAYYY more likely is your ovaries pumped out some extra estrogen when you tested - OR that your test site (finger prick? venous?) was contaminated with some gel. Do you apply it to arms or only to legs?

[Hopeful2]

Hi Joziel.

Thanks so much for taking the time to reply.

Yes I'm in the UK. I apply it to my thighs and had the standard arm blood test. I think your right with the symptoms I'm having my oestrogen must be low. Do you think maybe I should ask to up utrogestan too then. Its such a struggle to get a balance. Really appreciate your message ☺ x

[joziel]

Yes for sure - if you don't have any side effects from the utrogestan, I'd increase that (you haven't said how much you are taking at the moment, or whether sequential or continuous). And ask to increase estrogen too.

[Hopeful2]

Hi Joziel. I take 100mg utrogestan days 1-25. Would it be ok to go up to 1.5 Sandrena and still stay on the 100mg utrogestan if I had trouble upping it? Sorry for all the questions. Thank you.

[joziel]

Ideally, you'd increase your utrogestan at that dosage because it's the equivalent of 75mcg patch or 3 pumps of gel, which is the point where it's recommended to increase.

However these things are very individual because no one can predict how well you're absorbing either product. You could try remaining on the current dosage but if you get any unscheduled bleeding, you would need to increase. Alternatively you could try increasing to 200mcg for the last half of the month. So you'd have a break to bleed from Day 1-5, for eg - then day 5-14 you'd take 100mcg, then day 14-26 you'd take 200mcg. That would reduce the number of days you're at 200mcg for.

There is no absolute rule, it's all a crap shoot. You might find that you like the extra utrogestan as well. It can help with hot flushes according to Dr Prior's research, in itself, and also helps with sleep.

[Hopeful2]

Thank you Joziel for all this information. I am going to try and make an apt tomorrow. Thank you for taking the time to reply 💐 x