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[Ana21]

Hi All!

An excellent article from Dr. Jen Gunter on The Vagenda:

A Master Class in Hormone Levels and Doses in Menopause
Understanding the Concerns with Ultra-High Doses

https://vajenda.substack.com/p/a-master-class-in-hormone-levels

I wish I could paste the text here so it was searchable on the forum, but it would have to span 3 posts in order to comply with the limit on message length.

Hope you're all doing well.

[Gnatty]

I read that earlier and I thought it was a really good article. There is so much we don't know still! And so much stuff out there that simply isn't yet backed up unfortunately.

[Dotty]

Thank you… I’ve bookmarked it to read.

[Gilla999]

Very interesting. I would have liked to see more scientific elaboration on the two statements below and why she thinks blood tests are useless though, as these are pretty generic (but very important) statements:

- If studies showed that blood tests were worthwhile, they would be included in the guidelines.
- Estradiol levels can underestimate estrogen exposure due to how hormones are metabolized, making estrogen seem low when it is not.

[Gnatty]

Re the blood tests, I think the problem is that even someone on a steady dose, post menopausal, that oestrogen blood levels rise and fall during the day, so you could have a low reading and think goodness that means I need more whereas if you had had a second blood test three hours later your level might have been more than double or triple. Louise Newson showed a chart of a woman's oestrogen levels during the course of one day. This woman was taking regular HRT, feeling settled etc and the curve of the graph went up and down like you wouldn't believe. Also we are all different. So a lot of women get bone protection on a very small dose of oestrogen yet there will be some that need more. There are just so many variables. I feel we are still feeling our way in the dark half the time!

[Seasidegirl]

Very interesting. I would have liked to see more scientific elaboration on the two statements below and why she thinks blood tests are useless though, as these are pretty generic (but very important) statements:

- If studies showed that blood tests were worthwhile, they would be included in the guidelines.
- Estradiol levels can underestimate estrogen exposure due to how hormones are metabolized, making estrogen seem low when it is not.

I've only skimmed the article at the moment but that was my thought about some of it.   Sweeping statements with no evidence.   

I know she's in the US but we do know that the NHS has guidelines that deliberately reduce demand to reflect the funding available. 

I absolutely agree that there is so much variance in estradiol levels that there isn't a simple hba1c type blood test (blood glucose), however surely they can demonstrate if someone is consistently under what is "normal" at whatever stage of their cycle.

I guess that leads us to insufficient research to give a range of what is normal?

What gets me about all of this is that we have doctors making sweeping statements which others then parrot going forwards.

[CrispyChick]

I think this bit resonates with me:

"MHT can make symptoms worse in the menopause transition as it doesn’t help the fluctuations in hormones and makes high levels of estradiol even higher. The pill is often the best option here as it stops ovulation and stops the chaos."

I was told by the NHS meno clinic to try every pill possible for my peri symptoms. Whilst this hasn't worked for me, hrt was even more horrific - very quickly. As it simply topped up my already fluctuating, and at times, very high E.

I don't feel this method is portrayed well on this forum. And that's why I made the point on the LN thread about lack of 'expert' input.

Time and time again I've seen members instruct other members to stop the pill and move to hrt. The facts just aren't out there. Or maybe they are in some places.

I do find this forum very HRT heavy. And when that doesn't suit, or someone doesn't want to take it, you feel you have to post in the 'alternatives' thread 

[Gilla999]

I've done quite a bit of reading into the circadian pattern of Estrogen levels but could never find charts showing actual levels/ranges of fluctuations, just a general "when it's highest or lowest", so would be really interested to see Louise Newsom's chart if anyone has a link to it!

I've done many, many blood tests over the last four years (too many) but except for the odd anomaly found them to be pretty consistent to within 100 pmol when testing on the same day of my cycle each month. But I'm open to being wrong/misled about it! I am also interested in the theory/statement that Estrogen levels can be under represented in blood tests, as it's something I've heard before and would certainly fit with my picture - I've just never been able to find any science given behind that and it's a shame she hasn't elaborated in her article, as that's quite a big statement to make.

[CrispyChick]

Good points Gilla.

I've done numerous blood tests too and they always correspond to how I'm feeling. So I find them very useful to reinforce what I 'think' is going on in this peri hell.

[Gnatty]

Hi Gilla I saw the chart on one of her Instagram posts so I'm not sure how I would find it again. I will have a search and if I do, will post it. I guess it might be on her Balance app....

[Ayesha]

I do find this forum very HRT heavy. And when that doesn't suit, or someone doesn't want to take it, you feel you have to post in the 'alternatives' thread 

My interest is GSM (Vaginal Atrophy) and its treatment. I can spit bullets sometimes when I read on the forum woefully bad advice given out such as ditch the topical treatment and start systemic HRT and your symptoms will disappear. I have stopped confronting the posters and instead report the post because bad advice is dangerous for women who are only just getting menopausal symptoms and only just beginning to feel the affects of GSM.

[CrispyChick]

Oh. What happens when you report it Ayesha??

I never thought of that. I've just become so used to ignoring it all. But it is a problem for newer women to mm.

That's why I posted about lack of expert advice. I just don't get how this forum can be pushed by the BMS when it is literally all just normal woman with either anecdotal evidence, or strong opinion!

[Gilla999]

Agree with all you're saying Crispy and Ayesha! Though it is always well intended.

Gnatty, thanks for that - I'll have a little scour of her Instagram 

[bombsh3ll]

Interesting article, refreshing to hear a doctor who understands the value of the combined pill in peri which is my chosen option to keep me bleed free and hormonally stable, rather than steering everyone towards body identical hormone therapy, which frequently achieves neither amenorrhoea nor hormonal stability until someone is postmenopausal.

I don't necessarily agree with her about settling for early follicular estradiol levels though when on hormone replacement - whilst this may suit some people I personally never felt my best during that week when cycling naturally, and thrive within the range reflective of "average" levels across a normal menstrual cycle.

Also some of the studies showing "bone protection" at very low estrogen levels only showed superiority to placebo, i.e. a slower rate of loss, not that BMD was being maintained or increased.

[Ayesha]

Oh. What happens when you report it Ayesha??

It goes to admin and they will act on it if necessary, which they have done recently.