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[bombsh3ll]

That is generally true but for someone with no uterus, or not bleeding due to an IUS or ablation, a raised FSH can be definitive, however it may not necessarily influence clinical decisions so if you are within the expected clinical age range the NHS might not fund it.

For others eg with an IUS or ablation it can be helpful to know when contraception is no longer required although that isn't you.

It should be done if someone is young to avoid undiagnosed POI/early menopause.

[joziel]

bombshell I think you've hit the nail on the head really. It is so hard to pick your way through this and to determine whether there really is any scientific hard-backed evidence that older women 'need' less estrogen, or whether it isn't more the case that providers would prefer to give them less estrogen because they are (always) so terrified of it.

And then there is also a big difference between what a woman 'needs' for symptom control and what a women 'needs' for ongoing prevention of osteoporosis, heart disease, blah etc.... Just because someone feels their symptoms can be controlled with less, doesn't mean they are necessarily gaining all the benefits. What does it mean to 'need' something - and who gets to determine how much of a hormone someone 'needs'.... This is just prescription power-play, as usual.

[Lesred]

This is really interesting! I am 3/4 years post menopausal and can’t quite believe how bad the symptoms still are so off I trotted to see the menopause nurse practitioner at our surgery the other day! I took myself off hrt a year ago as I felt it wasn’t really needed and side effects were annoying, but after about 6 months oh boy, not great! Anyway she said there was no way I was going to feel better without hormones and was shocked I was put on such a low dose ( 1 pump Oestrogel + utro continuously) she said the starting point should def be 2 pumps! That was her starting point even post meno! Soo different to the last person I saw who wanted to be very slow and careful! So my experience has been that attitudes to post menopause hrt seems to have changed in a year and half! And this thread has been very timely! I would also say that obviously if you are ticking along nicely that’s great, I was struggling so hence the reason for hrt again!!

I do feel us post menopausal women sometimes get left in the ether, with no one quite sure what to do about us and often under prescribing as we “should” be on an even keel by now, sorry probably a little over dramatic  . Anyway let’s hope this time round is more successful! And yes what indeed constitutes an older woman? I’m 56 is that an older woman? No idea!
 

[Epona52]

Noooo lesred, your not old at 56,
I think it all depends on our mental and physical health, 

[bombsh3ll]

I wish someone would clone that nurse

[Lesred]

 

[Indigowings]

If you are doing well, symptom-free and have no signs of excess estrogen like unwanted bleeding or sore boobs, there's zero reason to change anything.

So is it a reasonable practice to use as much as you need to produce sore boobs, and then back off a bit until they don’t hurt anymore? Then THAT amount is the right dose for you?

[bombsh3ll]

I would not recommend deliberately aiming for symptoms of excess, then dialling back a bit.

The target level for each individual depends on her own physiology and treatment objectives.

Some HRT users (and prescribers) are seeking only palliation of vasomotor symptoms. This can be achieved with very low starting doses titrated to symptom relief.

Others like me choose to aim for physiological replacement, approximating the average estradiol levels across a natural menstrual cycle with the exception of the ovulatory peak, and higher than the early follicular phase as most women don't feel their best during menstruation.

I will personally be maintaining a plasma level of 400-500pmol/L which I know from having had bloods done premenopausally that I thrive at, and this also guarantees bone protection in as far as anything in life can be guaranteed, however I will also get a DEXA every 5 years.

Should new evidence emerge regarding optimal levels for other health outcomes I will be very interested to read this however doses used in clinical practice today are well below the therapeutic doses of the 1990s, hence outcomes for chronic disease prevention in the post WHI era have been disappointing.

[Mary G]

I think it depends on the individual and what your actual problems are.

Like bomb says, hot flushes and night sweats are relatively easy to get rid of on a lowish oestrogen dose but if you want to prevent osteoporosis or you have anxiety and depression, you probably need more.  Then you need to consider the fact that oestrogen levels continue to fall well into your post menopause years.

I was able to keep daytime sweats at bay with one pump of Oestrogel but then my silent migraines made a comeback so I had to increase to 2 pumps of Oestrogel because my particular type of migraine auras are caused by low oestrogen.

Sometimes we get women on here who find their HRT suddenly stops working well into their 50s and 60s and they need to increase their oestrogen dose while others are able to keep going on a lower dose but obviously we don't know if they are getting a high enough dose to prevent osteoporosis or cardiovascular disease.

[lizzy76]

Hello,

I've just had a blood test and have got an oestrogen level of 123 pmol. Dr says this is too low. I'm on a 50 patch and a half pump of oestrogel. I feel pretty good but have sore breasts. Apprehensive about increasing but have oestapaenia (which I can't spell).
Think I'm otherwise actually fairly menopause symptom free.
Any thoughts? Should I increase oestrogen?
I'm post meno by the way.
Can't find any suggestions about optimum post meno oestrogen level

Thank you!

[bombsh3ll]

It comes down to your individual needs and treatment goals.

That is a relatively low estrogen level and it would have been much higher than this when you were menstruating - did you have sore breasts frequently then?

Sometimes it can be the progestogen not the estrogen causing this.

Tibolone is another good option for bone protection.

Evening primrose oil and a vitamin B complex can also really help with hormonal breast tenderness - I got this advice from an eminent (male) gynaecology professor many years ago, and I thought it was BS that anything over the counter could help but it was cheap and I tried it anyway - it worked so well I no longer had any warning when my period was coming!

Also, some women do manage to maintain (or at least lose more slowly) bone on 50mcg patches so your other option is getting serial DEXA scans on this dose.

The addition of testosterone if you can access it is also bone protective, as well as helping to prevent frailty and sarcopenia.

[joziel]

lizzy, yes for sure you should increase estrogen if you have osteopenia and an estrogen level that low.

It is very normal to have sore boobs for a few months any time you increase estrogen, but usually it settles down 3-6 months after an increase. Besides, sore boobs are not dangerous or a sign of anything to worry about, so as long as they are not so sore they are impossible to live with, don't worry!

[lizzy76]

Thanks for your advice Bombshell and joziel, I have upped the patch to 75 and maybe will go higher.

I have also started taking evening primrose oil which has already made a big difference to my breast pain after only a few days. I had presumed the breast pain meant I had too much oestrogen but obviously it didn't!

[CazzaC]

I am 69. I am on a high dose of HRT and have tried to reduce my dose several times. Each time the symptoms return I do not absorb well. I hope to stay on HRT  as I believe that the benefits are worth it