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[M steel]

Hi - I had a similar issue where for 2 years everything was fine and then I started to get the symptoms back and when I had a blood test I had very low estrogen 35.  I switched to the Patch and over the course of 6 months had to keep increasing my dose, I also tried different places to stick it because it didn't seem to do anything when I stuck to my bum!  (things did not change quickly for me), although blood tests did show they were rising but slowly.  1 year on they have now settled around 300. The reality is that all women are different regarding absorbing and for some of us even when we change our dose it takes a while for it to kick in.  I found it took about 3 months for me to feel the improvements.

[Holsy]

Hi M Steel

Thanks for your message, I've come to terms with the fact that I have to be patient & have yet another blood test in a few weeks, so I will have been on a much higher dose for 8 weeks by then, so fingers crossed that it is still creeping up.

What were you taking before the patch? Gel? Once I get my levels up to a decent level, I would like to try the patches again as they are so much more convenient, although a little unreliable in terms of availability. What strength of patch are you on, if you don't mine me asking?

I'm glad that your levels are at a good point and that you're hopefully feeling much better. xx

[joziel]

Holsy, if you were only at 82pmol on 3 pumps (or 2 even), it's very unlikely you are going to suddenly be at 300+ with 4 pumps. I mean, it's unlikely you will absorb that much more from that little extra.

But you also don't need to switch to oral, you just need a higher dose and/or a combination of gel and patches - probably privately because your GP may be unable to prescribe this.

I have been as high as 12 pumps of Oestrogel (a day, yes - 6 pumps AM and 6 PM). Unfortunately this didn't give me any extra estradiol than 6 pumps did, because there is often a limit to how much we can absorb of one 'route' of application.

So, my (private Newson Health) consultant then reduced my gel back down to 6 pumps - which was the highest I could absorb - and we added in patches and gradually increased those.

I am now on 200mcg Estradot patches PLUS 6 pumps of gel a day. My estradiol levels vary between 650-880pmol. I am finally able to sleep properly and really need my dose this high.

I hate putting the gel on and waiting for it to dry (I do all 6 pumps at night) and I would like to try moving totally to patches and coming off the gel. So then I will be on 350mcg patches. But at the moment there's an Estradot shortage so I'm delaying this(!). (This month I've been prescribed my 200mcg as 25 patches, so that means wearing EIGHT 25 patches at a time....!!!!)

I would really recommend you go private, get your private consultant to write to your GP and tell them to prescribe these higher transdermal doses - which they should then be happy to do. That's what happens for me, I get my meds on the NHS.

I would not switch to oral E because besides the increased risk of blood clots, it also increases estrone (the bad inflammatory and weight-gaining estrogen) and it results in worsening blood lipid panels (cholesterol) - none of which happens with transdermal HRT. Better to keep raising that transdermal dose and to combine various delivery methods.

[Holsy]

Hi Joziel

Thanks for you message. I'm sorry that you're suffering with the estradot shortage and having to wear so many patches, but we all do whatever is required to feel more normal don't we? It's annoying that these shortages are allowed to happen, they're playing with women's lives. This is one reason why I am a bit wary of going back to patches now, even though I loved them when they worked for me.

Hope you manage to get on just patches, as the gel is a pain.

I do feel that my levels are increasing slightly and am keen to see the results of my next test. I don't think that my GP would be comfortable prescribing more than 4 pumps or adding patches too, so I would then have to go private. I will discuss my options with her though.

Thanks for the added info on oral E, another nail in the coffin for oral E for me.

[Wrensong]

Hi Holsy, sorry I missed your questions from weeks ago, but I haven't been on the forum much.  How are you doing now?  Hope you have been able to make some progress.

[Holsy]

Hi Wrensong, no problem at all, everyone is busy. I was actually wondering how you were getting on too.

My levels were up to 147 on 7th March, so going in the right direction albeit very slowly. I did force the issue about low iron, but I don't think the ferrous gluconate is agreeing with me, so I have just ordered some solgar gentle iron. I'm hoping that's what it is anyway and not absorption issues again. I have requested another blood test as some of my symptoms are appearing again!! I would really love to go back on the patches & may try them if my levels are still increasing. I'm hoping I was perhaps just on too low a dose on the patch.

Thanks for asking. Let me know how you are getting on. Hope you're getting on well. Take care. x

[joziel]

Holsy, I think it sounds like you need MUCH more transdermal estrogen and are probably going to need to go above the licensed dose to get there (100mcg).

Just for reference, I'm on 300mcg of patches now plus 6 pumps of Oestrogel at night. This gets my serum to between 650-850pmol. I'm about to do another Tasso home test next week because I'm trying to get my progesterone up more by dosing twice a day the second half of each cycle and I'm also not sure what I'm getting from the Estradots now I've been forced to use about 650000 25s.

(And I just heard today that the Pharmacy can't even give me 25s this month. I'm so fed up....)

[Wrensong]

Hello Holsy thank you for the update  .  147 - was that on 4 pumps  ?  Still nowhere near as high as you previously needed to feel well, is it & symptoms suggesting you need more too. 

What do you feel most comfortable with as next step?  Did you ever try a 100mcg patch, sorry if you've said before - I reread this thread before replying to refresh my memory but my sleep-deprived, ageing brain is easily defeated   

If you want to continue with transdermal & your GP doesn't feel she can agree to combine methods to increase your levels, I think you may have to go private to get this sorted before much longer if within your means as Joziel suggested.  But didn't you say you tried patch with Lenzetto at one point, was that without GP's involvement then?  If she was OK with that, though Lenzetto is generally considered to be a weak method, if you felt some benefit from using it with a patch, perhaps you absorb Lenzetto better than average & it might just be worth trying say 100mcg patch with some Lenzetto (or gel, GP permitting).   Or what about talking to her about changing from Oestrogel to Sandrena if that's new to you?  Some women report doing better on that.  My first ever MS added Sandrena to Estradot many moons ago & though we didn't test levels I felt as though I was getting a lot from it & in fact had to stop it due to intolerable symptoms of high E.  I've tried it on its own since but just don't get on well with gels as sole method, as I think the peaks & troughs are too great for me.

I'm sorry it's proving so difficult to get back to where you were, but I think there's still leeway for things to improve for you without going to oral if you prefer not to.  Not that I'd discount that route if all else fails.

Thank you for asking about me; not doing well I'm afraid.  In answer to one of your earlier questions I missed - I've tried the lot: patches of various brands, both combi & oestrogen only, the 2 gels, Lenzettto, oral, testosterone & before hysterectomy every form of progestogen that was available for HRT use at the time.  We've discounted Tibolone & E implants as unwise for me due to an aspect of my medical history.

Been inexplicably worse the past 2 years & can't seem to make any progress whatever we try.  Btw, GP though v helpful, doesn't test my hormone levels.  I've had to go private for that for many years, initially as I'm an atypical hypothyroid case & GPs' hands are tied in terms of what the NHS permits as regards monitoring for us.
Wx

[Holsy]

Hi Wrensong
Thanks for your reply. Yes 147 is on 4 pumps. I'm suffering with period type pains though too & I don't know if that is because of the gel, hence stopping the iron, stopping the kefir that I have been taking for a couple of months & stopping glucosamine & chondroitin for my joints that I have also been taking for a few months. I'm a bit loose too, so I don't know if this is down to lack of iron or the oestrogel too. GP is talking about me coming over the gel too to see if this is the cause of my stomach cramps & being loose, but I know my anxiety & irritability will be too much without something.

I have a blood test in a couple of weeks, stool & urine sample too. So if after that my levels haven't increase I am going to ask for a 100mcg patch as I haven't tried that. I went up to 75mcg but my levels barely moved but I may not have been on it for long enough. The doctor doesn't want me to go beyond 4 pumps, but I could always do that myself and just request another blood test for a trial period. My plan is to get my levels on the gel up to at least 200, then request the 100 patch for 8 weeks then test again. Or like you say I'm happy to even try 75 patch with lenzetto as that did appear to work for me & the GP was ok with 50 patch & lenzetto. The only thing with lenzetto is it being applied to the same place all of the time & whether that will become an absorption issue again at some point. Isn't the sandrena a bit of a faff, worse than the gel? Worth trying I suppose if the patches fail again. As you say my last resort would be oral which I would use out of desperation.

I'm so sorry to hear that you're not doing well. It is so frustrating and disheartening to hear that nothing works for you and it irritates me that cases like yours are not researched and a solution found. We should all lobby for these cases to be taken on and a solution sought. It's unfair that you have to pay for your tests too. I really hope and pray that you find a treatment that works for you Wrensong. Sorry that I can't offer any suggestions that might help. I hope you have a lot of supportive friends & family.  Big hugs xx

[Wrensong]

Holsy, no please don't be disheartened by what's going on with me, it absolutely doesn't mean you will not be able to find the right regimen yourself.  I have an unusual medical history & several other chronic conditions in the mix known to be affected by & complicating how the body responds to HRT, meaning I was never likely to be the poster girl for it.  What I said in my post above in reply to your question was out of context - not all those products used over the 9 years failed for me, but my general medical & gynae history has also changed in that time making some of them unwise/unsuitable for me now.  Among other surgery since starting HRT nearly a decade ago, I had BSO at 56, then a long gap with no HRT, then more recently total hysterectomy & in the interval following each of those ops my response to HRT has worsened & I'm now at the stage of wondering whether I'm at the end of the road with it.  Never my intention, but what is it they say: life is what happens when you're busy making other plans  ?!  There was a time when I felt considerably better with HRT than without, which is why I feel it can be helpful for anyone having a difficult menopause & well worth persevering with.  I also feel we do the forum a disservice if we don't tell it like it is.  If only success stories get posted here it can leave women who struggle with HRT feeling inadequate, as if when it fails for them it's their fault. 

But this is your thread & not about solving my probs  ! 

As it can be almost impossible to distinguish period type pain from pelvic cramps coming from the bowel & you have looseness too, my money's on the kefir as source, having eaten it myself & found it very powerful.  And yes, iron supplements can be a bowel irritant too.  Hopefully it's down to one or other, rather than the Oestrogel & stopping them will enable you to find out which.

I think the 100mcg patch sounds a good plan & if your GP's OK with adding Lenzetto if you then find you need more than the patch, that might be the solution without having to go private.

The only thing with lenzetto is it being applied to the same place all of the time & whether that will become an absorption issue again at some point.

Lenzetto can be used on inner thigh as well as arms, so no worries about saturating one application site.

Isn't the sandrena a bit of a faff, worse than the gel?

No, Sandrena is just another estradiol gel preparation, more concentrated than Oestrogel so it can be useful for women who are running out of body parts for the bigger volume per dose of Oestrogel.  So yes, definitely worth trying.  It comes in tiny sachets so you don't have the issue of variable amounts from a pump that some women report happening sometimes with Oestrogel as it runs down.

Thanks for your good wishes Holsy  .  That's so kind of you.  Everything crossed for you & every reason to think you'll get back to where you were given enough time to experiment.
W x

[Holsy]

Good morning Wrensong

Thanks for your positive reply. I was actually feeling disheartened for you as I hate hearing what other women are also going through, without anything positive in sight. But you sound as though you have accepted the way things are and you're making the most out of it, so all hats off to you. Totally agree with you about being honest on here, even though there are a lot of sad stories. Sorry to hear what you have been going through.

I'm hoping that it's the kefir and/or iron too. Won't find out for a while. Fingers crossed.

Thanks re: Lenzetto, although that didn't always give the same dose. I do put the oestrogel on the inner thigh too, so again the same place, but 2 in the morning and 2 in the eve. I do get variable amounts after about day 11, so Sandrena may be an option thanks. I'd love to not have to need any of it.

Thanks for your best wishes too and for your replies, means a lot and very helpful too. Very best wishes Wrensong.  xx

[Wrensong]

With the Lenzetto, I was thinking you'd potentially be using it with a patch (not gel) applied to butt/abdo, so no other HRT product on arms or legs, meaning no conflict with application site for Lenzetto  .

Not really at peace with my own HRT outlook yet, especially as I have osteopenia to think about & GSM has never been adequately controlled on local HRT alone.  I'm waiting to see how a recent tweak to my thyroid regimen pans out (possibly together with a trial of another medication, pending GP approval) as it's all interconnected.  But I sense for whatever reason barring something unsuspected ongoing, my body is now struggling to cope with systemic HRT & there's only so long you can go on trying to force a square peg into a round hole.  If I have to come off it, at least I'll be free of the all consuming imperative to keep looking for a solution.

Good luck with it all Holsy & please let us know how you get on if you feel like sharing.  You can always drop me a PM if I'm not around & you want to chat.
Wx

[Holsy]

Sorry I didn't write that very well. I meant I'd be putting the lenzetto on my arm all of the time, like I'm putting the gel on my inner thigh all of the time. As I'm wondering if that is some of the problem for me, with placing the products in the same place all of the time. I also spoke to a pharmacist about it yesterday and he agreed, that it could be part of the problem. Hence a patch & lenzetto or patch & gel combo as you suggested, may be preferable, as that appeared to work last time, but the patch possibly wasn't strong enough or because I was only applying one spray of lenzetto.

There's always something else isn't there! Sorry to hear that you have osteopenia and GSM issues too. Really hope that the tweaks that you are making work for you. Know what you mean about forever looking for solutions, it becomes exhausting.

I really wish you well going forward and hope to hear that you're making progress. Thanks for the offer of a chat, the same goes for you too. xx