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[Epona52]

Hi,
I have just got my blood test results back and despite being on four pumps of oestrdiol my reading came back as 175,
Does this mean that I am a poor absorber or is this a normal result 🤔
Testosterone came in at 1.08, I am just trying to find out if I'm post menopause.
Best wishes x

[bombsh3ll]

These results will not tell you if you are postmenopausal.

Assuming the estradiol is in pmol/L this tells you that you have a relatively low level of estrogen, but this is not in the untreated postmenopausal range, and this level can sometimes be seen around the lowest point of a normal menstrual cycle.

It could also reflect a low level of exogenous estradiol from hormone therapy in a postmenopausal woman.

If this level remains the same, as in it the second scenario, it is insufficient for bone protection. It may be sufficient to suppress hot flushes and avoid vaginal atrophy but you may still have other symptoms of hypoestrogenism.

Your testosterone is in the normal range. It is not particularly high but wouldn't qualify for replacement on the NHS.

If you have had no periods for 12 months or more, in the absence of any treatment that would stop them or any other explanation eg a hysterectomy, severe underweight, chemo etc then you are postmenopausal.

If you cannot use periods as a guide because you don't have them for another reason, then an FSH is the best test to get.

If it is sufficiently elevated you can assume menopause.

[Epona52]

Thank you for your kind reply bombsh3ll,
My fsh came in at 28, I had a hysterectomy at 34 so no periods, I also use a pea sized amount of testosterone called testogel made by besins on the nhs, 4 pumps of oestrdiol by begins,
I went to the doctors as still having symptoms like flushes, waking up hot in the night, morning anxiety, feeling flat, dry skin, and va, which is being treated with oestrdiol pessary, joint pain,
Having said all this the gp suggested that I may be a poor absorber, so was wondering if these results show that I am,
X

[bombsh3ll]

That FSH is not high enough to call it.

However if you were on hormone therapy when the blood test was taken this can suppress the result, so you could be postmenopausal in this case.

It is difficult to go by blood estrogen levels on gel as it peaks and falls off quickly, however your symptoms suggest undertreatment.

I wouldn't necessarily call you a poor absorber unless you were objectively an outlier.

However it is worth trying either an increased dose which is probably difficult to obtain on the NHS, or a different product if what you are on isn't achieving your therapeutic goals.

[Epona52]

Hi and thank you again for your kind reply bombsh3ll,
I didn't have any gel on for over 24 hours prior to testing so unsure if that made a difference, I have often thought of maybe having a different product to see if it helps with symptoms but I'm also sensitive to any changes, I will update when I have a follow up appointment,
Many thanks
X

[Epona52]

This was the lab's comment,
Laboratory comment on the fsh my result was 28,

Follicular Phase 3 - 9 iu/L, Mid cycle peak

up to 17 iu/L, Post Menopausal >25iu/L

[bombsh3ll]

Most authorities don't call it at 28iu on a single reading.

Guidelines vary between countries and societies but 40iu is commonly viewed as a cut off, however this is arbitrary, as values just below this certainly aren't normal.

To put it into context, untreated postmenopausal women often have FSH of 80 or 90iu.

However you are certainly well on your way, and hormone therapy would usually need to be withheld for at least 7 days to get a true reading.

There is little clinical value in repeating it however as it wouldn't change management, so doesn't warrant the discomfort of a washout period to get a true result.

[Epona52]

Thank you so much for your response bombsh3ll,
You seem to have so much knowledge about it all, so could I ask if I am getting the benefit of bone protection, it's only a worry for me as I already have osteoarthritis,
I was assuming I was maybe entering post menopause as I have felt more aches and pains than normal and been feeling flat, no energy etc,
X

[bombsh3ll]

To reassure you regarding the aches and pains and osteoarthritis, none of these are related to osteoporosis, which involves the loss of bone density.

Osteoporosis has no symptoms at all generally, and is sadly only often diagnosed after someone has a fragility fracture.

It is difficult to know if you are getting enough estrogen to protect your bones, as measuring levels on gel is tricky given its short plasma half life.

NHS literature cites 250pmol/L as the threshold for bone protection, the threshold I favour myself is Professor Studd's recommendation of 300pmol/L. These both pre-date the widespread use of gel or sprays, and are based on data from women using oral, patch or pellet estrogens.

I think if you are concerned about osteoporosis, particularly if you have risk factors such as a family history, smoking, low weight, steroid medication, malabsorption, coeliac etc it would be worth considering a DEXA scan.

This is the gold standard for assessing bone density, and can help guide your treatment decisions going forward.

If you have any risk factors you may be able to access this on the NHS.

[Epona52]

Hi bombsh3ll,
Thank you for all your replies they have been so informative and helpful,
I do use a high dose steroid inhaler one which I carry a card for, I had a bone scan years ago now which was all ok, and more recently had bone profile blood test done which was ok, the osteoarthritis is wide spread so I guess it's hard to determine if the pain comes from that or oestrogen levels falling, I have brought some vitamin d spray today so hopefully that will give me a boost as I don't absorb vitamin d and blood test is always out of range,
Thank you for your replies
Best wishes
X

[Hurdity]

To reassure you regarding the aches and pains and osteoarthritis, none of these are related to osteoporosis, which involves the loss of bone density.

Osteoporosis has no symptoms at all generally, and is sadly only often diagnosed after someone has a fragility fracture.

It is difficult to know if you are getting enough estrogen to protect your bones, as measuring levels on gel is tricky given its short plasma half life.

NHS literature cites 250pmol/L as the threshold for bone protection, the threshold I favour myself is Professor Studd's recommendation of 300pmol/L. These both pre-date the widespread use of gel or sprays, and are based on data from women using oral, patch or pellet estrogens.

I think if you are concerned about osteoporosis, particularly if you have risk factors such as a family history, smoking, low weight, steroid medication, malabsorption, coeliac etc it would be worth considering a DEXA scan.

This is the gold standard for assessing bone density, and can help guide your treatment decisions going forward.

If you have any risk factors you may be able to access this on the NHS.

Hi Bombshell

Please could you post links to the information and studies demonstrating these different oestrogen levels recommended for oesteoporosis protection. Both NHS and Studd papers. I have yet to find anything based on actual studies. Many years ago I found something which I recalled (maybe incorrectly) as suggesting a level of something like 160-180 but haven't been able to find it since - and I am thinking it was pmol/l. I would just really like to find a level based on studies ie actual trials ( which is what I think I read years ago).

Hurdity x

[Hurdity]

Epona 52

I was going to add a new post about my situation but that is a very low oestrogen result from 4 pumps of gel and I would say you are a poor absorber. I have tried patches, (many years), and more recently oestradiol spray and estrogel and on the latter - my levels went down to something like 50 ish pmol/l. That was I think on 2 pumps whereas on patches my levels have always been much higher. My levels are back up to the 200 mark since going back to patches.

So my recommendation would be - why not try patches? I like Evorel though for many years used Estradot.

Hurdity x

[Epona52]

Hurdity,
Thank you for your kind reply,
During covid I was sent some patches instead of gel as there was a shortage but I never took the leap to try them as anxiety and meno had really taken a hold of me, I was also sent some sandrena gel which I did try but my goodness that sent me all over the place, these last five years have been the hardest and I sometimes wonder why now, has it been the gel all along? I was never offered any other treatment when I saw the doctor regarding symptoms still present on gel, each time the dose was increased, she told me some ladies go up to six pumps but the max licenced dose is four pumps,
I will say I have never found a completely settled place with the gel, so yes maybe patches are an option, just read that they too often have shortages,
Best wishes
X

[AmandaJR]

Hurdity, here is mention of 250pmol for bone protection:
https://www.chelwest.nhs.uk/professionals/gp-hrt-advice-guidance

[Epona52]

I've copied this from the nhs website that AmandaJR has mentioned,

A serum estradiol of at least 250pmol/l is required to promote bone metabolism and reversal of bone loss – change estradiol dose and brand as required

My results were 175pmol and the coment next to it was normal no action,
I'm on max dose of gel 😌
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