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[Kathleen]

Hello ladies.

Just a quick question for you.

I have noticed from my diary that I will need to book an appointment with my Senior Nurse Practitioner soon to discuss my HRT. I last saw her in April and she told me that we would need to review in  six months time.

I have often mentioned on the forum that most of my physical meno symptoms have resolved or are being controlled by my HRT but my emotional ups and downs continue to cause me problems.  The last time I saw the nurse she said that a 200 pmol/L blood level of Oestradiol would likely stabilise my mood  and I wonder if any of you lovely ladies had some opinions on that?  I realise that 250 pmol/L to 300pmol/L  is recommended for bone health but is there a similar level for the mental side of the menopause? My last blood test showed a level of 139 pmol/L which was an increase from less than 78 pmol/L in April this year.  It seems my levels are going up but still not at 200 which may explain my ongoing issues.

I may be clutching at straws here but I would love to believe that my sanity will return as soon as my oestrogen is at a decent level!


Many thanks ladies and I look forward to reading your opinions.

Take care everyone.

K

[Dotty]

Hi unfortunately there is no magic answer to your question and everyone is different . You might feel fine on a low oestrogen level but someone else might need a much higher level to feel right.

139 is low though. You are likely to need a much higher level. I think Professor Studd advocated very high levels for the mental side of menopause.

[Kathleen]

Hello Dotty


Thank you so much for responding.

I am sure that you are right and that the levels required are a very individual thing.

I understand that 150 pmo/L is expected to be achieved from my dose of Sandrena gel and I am obviously below that currently.

Whatever the magic number turns out to be I hope I reach it soon!

Thanks again and wishing you well.

K.

[margherita]

Dotty is correct that Prof Studd advocated much higher E2 levels for depression, ie. from 600-800 pmol

[Banjo1973]

Hi Kathleen,

Can I ask what dose you are on and what other hrt meds do you take?

[Kathleen]

Hello Margherita.

Thank you for your reply.

When I was with Newson Health I was using about six pumps of gel and my Oestradiol levels were about 600 pmol/L. Although my moods were normal part of the time I had times when I felt anxious and emotional and had meltdowns so I wasn't stable. The main problem however was that I had increasingly painful breasts and then spotting and bleeding. As we know, the first response to any bleeding is to reduce the oestrogen dose which I was forced to do. As a result of those experiences and other episodes of spotting, I am reluctant to take a high dose of Oestrogen again.

I do appreciate your post though and I understand that highly E levels can be the solution for many ladies.

Thanks again and take care.

K.

[bombsh3ll]

The first response to bleeding should be increasing the progestogen not a knee jerk reduction in a therapeutic dose of estrogen, unless there are symptoms of estrogen excess - sore breasts is one so it was probably reasonable in your case.

If you are subtherapeutic at 200pmol/L but overtreated at 600pmol/L why not shoot for 300- 400pmol/l and see how you get on?

I'm at 390pmol/L on Zoely and feel like this is my ideal. We are all different and others might need more, some less.

[Kathleen]

Hello bombsh3ll

Thank you for your reply.

As I recall I had sore breasts for quite a while when my Oestradiol levels were 600 so I think I was over treated for a while. I was with Newson Health at the time and my doctor there was very keen on keeping my progesterone dose very low consequently I was using Utrogestan vaginally on alternate nights. I had experienced a pinkish staining for a while but then I missed one dose of Utrogestan and the bleeding began. This was a while ago but I don't think increasing Utrogestan was mentioned.

I am hoping that as I continue with my current HRT  ( one 1 mg sachet of gel daily and 100 mg of Utrogestan orally at night) that gradually my blood levels will increase to a therapeutic level. I understand that levels of 150 pmol/L to 370 pmol/L can be expected from this regime. I am also hoping that my therapeutic level will be fairly low and that I will hit that magic number soon. Seeing as I am at about 139 pmol/L now, a magic level of 150 pmol/L would be nice lol!

Thanks again for taking the time to respond and I wish you well.

K.

[joziel]

Your blood levels will only increase if you increase the estrogen. You can actually measure estradiol levels just 48 hours after increasing a dose to see how much is in the blood and this will be accurate - the only reason we don't test so soon is because symptoms take longer to change....

[Dotty]

Hi I agree with Joziel….if you’ve been on 1mg for three months then you’ve likely reached the maximum level that 1mg will give you. You’ll need to increase to raise your oestrogen level.

[Kathleen]

Hello joziel and Dotty

Thank you both  for your helpful comments.

 In March/ April this year my level was very low at less than 78 pmol/L and it has increased to 139 pmol/L which reassured me that I was absorbing the gel.
You both make a good point about reaching a maximum on one sachet so I will ask for another blood test soon to see if my levels have continued to rise or if I have reached the maximum.

Thanks again ladies and wishing you both well.
K.

[Hurdity]

Hi Kathleen

Just to add that the very high oestrogen levels recommended by the Studd regime were specifically to treat reproductive depression which he does define on his website (haven't looked recently!) which I see is still extant. This is very different from acheiving a level to treat more nebulous emotional symptoms - and to reach that magic spot that leads to general well being, above the minimum required to relieve flushes and sweats.

You may remember that years ago (more than 10!) on this forum we used to discuss just this - that the minimum dose required to eliminate the classic menopausal symptoms needed to be increased to give us a bit more of the zest for life and  restore the "oopmh" to some extent - though recognising it's never going to be completely restored as in our fertile years.

For osteoporosis protection - I have yet to see a study determining the minimum level - though I did read one some years back which suggested around 165 pmol/l minimum though I haven't been able to find it. Current recommendations all seem to quote each other ie other gynaeocologists.

You asked opinions on 200 pmol/l. Most of the 17 years I've been on HRT I would say my levels have been max 200-220 and that would be at peak time between patch changes though when the patch was due to be replaced it was lower.  As one example (admittedly not scientific!) I have not lost height at all even though I am now 71 - though I have never had a bone scan to check density, but at least I don't have osteoporosis. I would also add that I don't suffer from any negative emotional symptoms though surely these must also involve interplay with mental strategies towards life's issues and outlook - rather than completely relying on increasing oestrogen levels as a panacea. What I'm saying here is that even with levels of say up to 250 pmol/l you may still have the ups and downs you describe which I understand is distressing for you, but that oestrogen alone may not be the answer?

Once we are considerably post-menopause and on a stable dose of oestrogen, then I can't see that emotional ups and downs can be attributed to reproductive hormones as these will (should) be stable? If you were consistently lowish in mood then I would agree.

[ as an aside I am now on Lenzetto and levels have plummeted but I'll post about that on another thread!]

In your case, I would suggest increasing your oestrogen dose by say half a sachet, for a few months and see what happens. I'm not sure you would need to keep getting blood levels measured as they would surely increase to a reasonable  level on this dose though would perhaps be instructive to see?

I'm also not sure of the value/long term effect of replacing oestrogen to a level of 300-400 pmol/l at our age and into our older age, though I know you're a bit younger than me lol! Or perhaps better to say a bit nervous of this without adequate studies. Personally if we are to take HRT until we die, which in many cases will hopefully be in our 90's then I would want to settle on a little above the minimum for bone protection - if this has been determined recently by studies, or at least, say 200 - 250 pmol/l.

I hope this is helpful and that you don't mind my giving an honest opinion to your question?

Wishing you well anyway!

Hurdity x

[Kathleen]

Hello Hurdity

Thank you so much for your interesting post and of course I don't mind you giving an honest opinion on my question.

I realise that my mood issues may not be entirely hormone related, or even related at all,   but I have agreed to continue with my HRT regime for six months and then have a review with the menopause nurse. The 200pmol/L  target was her idea and I assume she thinks achieving this will benefit me.

I am close to your age ( I will be 68 next week) and I am also wary of higher Oestradiol levels  which is another reason that I am pinning my hopes on 200pmol/L.

I have read that mood issues may result from an AD dose that is too high or just unsuitable and I will mention this again to my meno nurse.

I am painfully aware of the number of times I repeat myself and thinking about it I have queried my AD prescription before but never followed through with it.
 
I think my strategy will be to optimise HRT and if that doesn't help I will explore other therapies. I will update the forum if I discover anything of interest.

Thanks again Hurdity and I wish you well.

K.