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[Dandelion]

It's said that often, postmenopausal women need less oestrogen, and, indeed, some do.
I am currently on 175mcg and looking like I need more.
I am 58.
100mcg was enough in perimenopause.
Also, my patches stick well, but my recent blood test showed low oestrogen still. Much better than the last test at 112, but still only 289, not enough to control symptoms.
So, it's also possible for women whose patches stick well to still be poorer absorbers than their lower dose counterparts. 

[bombsh3ll]

I have yet to see any published evidence at all that postmenopausal women "need less estrogen".

They frequently receive less estrogen, however this is due to prescriber behaviour rather than anything to do with their needs.

Often women will have an effective treatment unilaterally and arbitrarily slashed by their doctor without any discussion because they have reached a certain age.

If anyone cares to ask, many of them report worsened health and quality of life as a result, and often the onset of diseases such as osteoporosis, CVD and a decline in function and independence soon follows.

Most of us can probably think of someone like our mothers, aunts and their friends that this has happened to, and they experience visibly accelerated aging, which is difficult to watch.

[Kathleen]

Hello ladies.


Speaking personally as a post meno woman I would love to be okay without HRT.

I know several women who have never used it and they are fine, they don't have osteoporosis or CVD and they look well. 
Why that should be I don't know but they seem to have weathered the storm of the menopause and are now settled on a low but stable level of oestrogen.

Personally it is stability that I am hoping for as I take a break from HRT. I do have some VA  symptoms but they are mild. Perhaps they will worsen, perhaps not,   I will certainly consider topical HRT if necessary but for now I need a break from systemic HRT to see where I am naturally.

Perhaps this whole hormone thing is more nuanced than we know. Perhaps Oestradiol in HRT is too strong or inappropriate for some of us, perhaps the weaker Estrone that we continue to have in post menopause is a  better fit? Who knows? We can only experiment on ourselves and hope for the best.

The great thing about this site is that all opinions are represented and that is of value to us all.

Wishing you well ladies and take care.

K.

[sheila99]

I'm inclined to think it's an urban myth too, I only ever seem to need more. There's also the possibility that how we absorb changes over time.

[Wrensong]

Dandelion, yes absorption seems to vary greatly & as Sheila suggests perhaps changes over time. 

It's not so much that I feel I need lower dose oestrogen in my early-mid 60s to control symptoms than I did previously, more that side effects with higher blood levels seem to have worsened to the extent they outweigh the beneficial effects I formerly felt, meaning I've had to reduce my dose.  I remain symptomatic to some extent & have worried somewhat about reduced bone protection given osteopenia, but I'm becoming resigned to the situation.  I reason that some oestrogen replacement will be better than none & with other systemic conditions in the mix my priority has to be achieving the best overall balance I can.  My latest E2 result was ~170 on 30mcg Estradot (just below top of postmenopausal range) so a lot higher than the unmeasurably low result I had before starting HRT 10 years ago.

The great thing about this site is that all opinions are represented and that is of value to us all.

Kathleen, I agree but would add that I also find it helpful when longstanding members continue to post their experiences so that we can see how situations change, or not, over a period of some years & that may throw light on our own circumstances.  As I age, I'm very interested in the experiences & opinions of women older than me, in their mid-late 60's & 70s, whether on HRT or not, as I think the wisdom that comes with life experience can be invaluable, helping us develop new perspectives on issues we may only just be beginning to experience ourselves.

W x

[Mary G]

I think the idea of women needing a lower dose of oestrogen post menopause is a fallacy.

I reduced to one pump of Oestrogel (which translated into about 300 pmol) but my silent migraines aka brain stem auras returned.  I reduced because I wanted to reduce the progesterone dose and one pump of gel was keeping all the other symptoms at bay but a higher dose is needed (alongside verapamil) to control migraine auras which are caused by low oestrogen.  The minimum dose needed is about 400-500pmol.

Kathleen, when you say you know women who don't need HRT and look and feel great I would say how can they possibly know?  Nobody can know whether or not they need HRT until it's too late.  For example, they might sail through the first phase of the menopause looking and feeling great but then fall over in the second phase.  They may not have osteoporosis or CVD yet but they might develop dementia, a womb prolapse or need a hip replacement which is not always connected to osteoporosis. 

I'm afraid the harsh reality is a lack of oestrogen speeds up the ageing process.  It's a fault in the female design and ideally women should produce more oestrogen post menopause - men produce testosterone all their lives but obviously it drops off in later years.

My younger sister (58) thought she didn't need HRT and found the menopause a very difficult subject to talk about but thankfully she has finally opened up now that she is having problems. So she got through the first phase OK but has been caught in the second phase.  Unfortunately she has been diagnosed with osteopenia and is in danger of needing a hip replacement like our mother.  She has been given Evorel conti and it's completely useless and one year on she has no improvement in bone mass at all.

The point is, a lot of women think they don't need HRT only to come unstuck later on.  Also, a lot of women have problems which are caused by oestrogen deprivation but they don't make the connection.

[Dandelion]

I have yet to see any published evidence at all that postmenopausal women "need less estrogen".

They frequently receive less estrogen, however this is due to prescriber behaviour rather than anything to do with their needs.

Often women will have an effective treatment unilaterally and arbitrarily slashed by their doctor without any discussion because they have reached a certain age.

If anyone cares to ask, many of them report worsened health and quality of life as a result, and often the onset of diseases such as osteoporosis, CVD and a decline in function and independence soon follows.

Most of us can probably think of someone like our mothers, aunts and their friends that this has happened to, and they experience visibly accelerated aging, which is difficult to watch.

Louise Newson has said a couple of times, post meno women often need less.
I agree that these ladies often receive less oestrogen due to prescribing issues.
I've heard of someone finding out there 350mcg oestrogen was slashed when they got to the chemist, I think she was in her 50's but yeah, plenty women encounter unnecessary obstacles when they reach 60 - which must be awful because HRT can mean the difference between a good life and a bad one 😐.
Yeah, low or no hrt, is definitely a serious health risk, not to mention years of disability from osteoporosis etc an mental illness.
It really bothers me to see ladies all around me, not on hrt, suffering.
As I am on the autistic spectrum, I did not communicate well enough, the importance of HRT, in fact I never even got to that part of the conversation with my friends, they just switched off, I don't understand why, I looked it up and there are still taboos. Dr Naomi Potter said some women feel weak if they go on HRT, yet these same women might be on other prescription drugs, often for symptoms related to low oestrogen.
It's up to each and everyone whether to take HRT. I, myself, was planning on coming off, until I learned of these health risks. While it's everyone's choice to take or not to, it's best if the choice is an informed choice.
I thought I was informed about hrt till last year, and I am staying on.

[Dandelion]

Hello ladies.


Speaking personally as a post meno woman I would love to be okay without HRT.

I know several women who have never used it and they are fine, they don't have osteoporosis or CVD and they look well. 
Why that should be I don't know but they seem to have weathered the storm of the menopause and are now settled on a low but stable level of oestrogen.

Personally it is stability that I am hoping for as I take a break from HRT. I do have some VA  symptoms but they are mild. Perhaps they will worsen, perhaps not,   I will certainly consider topical HRT if necessary but for now I need a break from systemic HRT to see where I am naturally.

Perhaps this whole hormone thing is more nuanced than we know. Perhaps Oestradiol in HRT is too strong or inappropriate for some of us, perhaps the weaker Estrone that we continue to have in post menopause is a  better fit? Who knows? We can only experiment on ourselves and hope for the best.

The great thing about this site is that all opinions are represented and that is of value to us all.

Wishing you well ladies and take care.

K.

I didn't want to be reliant on a pharmacy for the rest of my life, which is why I didn't want HRT.
I also looked to the other ladies who appeared to be doing fine, some are super-fit, but dig a little deeper and some don't sleep enough, go to the loo more often, have things like dry eyes, mouth etc, muscular skeletal issues, high blood pressure, diabetes type 2, perhaps go off sex as it's a bit sore down there, none of us knew enough to put these down to menopause.
Also, heart attacks present different in women to men.

I now know that the seemingly symptom free women are still at risk as menopause is just doing it deadly deed silently.

Oestradiol is the oestrogen we lose in menopause, and as there are oestrogen receptors on every cell in our body, and lack of oestrogen is itself, inflammatory, we can now understand why the manifestations of lack of oestradiol is so pervasive, albeit silent in some ladies, at first.
The weaker Estrone is made by our bodies in the absence of oestrogen. This is made in the fat cells, so many of us accquire cuddliness around our middle, - I have that.

So, while I did make the choice to come off HRT last year, it wasn't an informed choice, so I did the opposite and went back to the Dr, and it turns out I need double to what I had.

[Dandelion]

I'm inclined to think it's an urban myth too, I only ever seem to need more. There's also the possibility that how we absorb changes over time.

I just think some women need more like me. Maybe some women who need less, do so, as it took more HRT to stabilise them in the fluctuation time of perimenopause, just a guess though.

[Dandelion]

Dandelion, yes absorption seems to vary greatly & as Sheila suggests perhaps changes over time. 

It's not so much that I feel I need lower dose oestrogen in my early-mid 60s to control symptoms than I did previously, more that side effects with higher blood levels seem to have worsened to the extent they outweigh the beneficial effects I formerly felt, meaning I've had to reduce my dose.  I remain symptomatic to some extent & have worried somewhat about reduced bone protection given osteopenia, but I'm becoming resigned to the situation.  I reason that some oestrogen replacement will be better than none & with other systemic conditions in the mix my priority has to be achieving the best overall balance I can.  My latest E2 result was ~170 on 30mcg Estradot (just below top of postmenopausal range) so a lot higher than the unmeasurably low result I had before starting HRT 10 years ago.

The great thing about this site is that all opinions are represented and that is of value to us all.

Kathleen, I agree but would add that I also find it helpful when longstanding members continue to post their experiences so that we can see how situations change, or not, over a period of some years & that may throw light on our own circumstances.  As I age, I'm very interested in the experiences & opinions of women older than me, in their mid-late 60's & 70s, whether on HRT or not, as I think the wisdom that comes with life experience can be invaluable, helping us develop new perspectives on issues we may only just be beginning to experience ourselves.

W x

What side effects did you get from the oestrogen?
I used to think that I was protected on 25mcg, as I was on HRT and it was better than none, but I learned it's still a risk.
I saw my Dr yesterday, and she put me on a treatment plan to raise by 25mcg to 200mcg and if symptoms persist to go up another 25mcg to 225 if needed.
I asked her if I could go up after that symptoms still persist but she said it could make me feel worse if my levels had got good and I piled more on without seeing her.
She only raised my dose as my blood oestrogen still had not got to 300, the UK theraputic range (I think).
I have a friend in her 70s who is not on hrt, she wants to go "au natural" she says menpause is all in the head, my grandmother used to say she just kept busy when symptoms came.
I think menopause can give us the opportunity to dig deep within as we get to this part of life, but I do fear disability and ill health. 

[Dandelion]

I think the idea of women needing a lower dose of oestrogen post menopause is a fallacy.

I reduced to one pump of Oestrogel (which translated into about 300 pmol) but my silent migraines aka brain stem auras returned.  I reduced because I wanted to reduce the progesterone dose and one pump of gel was keeping all the other symptoms at bay but a higher dose is needed (alongside verapamil) to control migraine auras which are caused by low oestrogen.  The minimum dose needed is about 400-500pmol.

Kathleen, when you say you know women who don't need HRT and look and feel great I would say how can they possibly know?  Nobody can know whether or not they need HRT until it's too late.  For example, they might sail through the first phase of the menopause looking and feeling great but then fall over in the second phase.  They may not have osteoporosis or CVD yet but they might develop dementia, a womb prolapse or need a hip replacement which is not always connected to osteoporosis. 

I'm afraid the harsh reality is a lack of oestrogen speeds up the ageing process.  It's a fault in the female design and ideally women should produce more oestrogen post menopause - men produce testosterone all their lives but obviously it drops off in later years.

My younger sister (58) thought she didn't need HRT and found the menopause a very difficult subject to talk about but thankfully she has finally opened up now that she is having problems. So she got through the first phase OK but has been caught in the second phase.  Unfortunately she has been diagnosed with osteopenia and is in danger of needing a hip replacement like our mother.  She has been given Evorel conti and it's completely useless and one year on she has no improvement in bone mass at all.

The point is, a lot of women think they don't need HRT only to come unstuck later on.  Also, a lot of women have problems which are caused by oestrogen deprivation but they don't make the connection.

This thread has been good, as I thought most postmeno women needed normal amounts of hrt, or less, unless their patches didn't stick well, until me with my welded on patches, came along and scoredbelow the theraputic blood oestrogen threshold even on 150mcg.
I got those weird migraine without headaches, with weird visual disturbances, caused by low oestrogen.
Yes, women who are not aware of any symptoms might be developing dementia on cardio vascular disease on the sly, also I hear osteoporosis is silent to start with.
It is a harsh reality that lack of oestrogen speeds up the aging process.
Last year, I sat down to a video by Dr Louise Newson warning about the risks of not replacing hormones, and getting the right type and dose, and it scared me tbh, 😱 I called her Dr Death when she appeared on my YouTube feed after that, but I did summon the courage to keep on watching and learning, and I did contact my Dr to revisit my own HRT.
Sorry your younger sister suffered. I am 58 too. The progestin in evorel Conti is synthetic, I have heard lots of people have problems with that, but do better on utrogestan/gepretix or vaginal pessaries made of real progesterone.
I did not make the connection with the medical problems I got in post meno as I was already on HRT, but my friends not on it, don't seem to want to know.
I struggle to communicate this to them, so I gave up.
Even with all the free education and information out there, I wonder, do we as individuals have to find out for ourselves, in this day and age still. I am glad I listened to my friend who told me about Dr Newson. Her stuff is great while you wait to see your own Dr, as is Dr Naomi Potter and Dr Barbie.

[Kathleen]

Hello again ladies.

It is true that I am one of the older members of MM  ( I will be 69 in September) and I have been posting on this site for a long time,
( a longstanding member indeed,  thanks for pointing that out Wrensong lol!).

All of this means that I have endured various aspects of the menopause. This has included being with and without HRT and suffering the effects both good and bad. It has been and continues to be a rollercoaster ride.

My aim now is to be stable both physically and emotionally and I am taking a break from HRT to see if that helps at all.

At the end of July I will post an update for anyone interested, with any luck my poor old mind and body will have calmed down and I can stop worrying about my hormones! I live in hope.

Take care ladies and wishing you all well.

K.

[Mary G]

Dandelion, I think a lot of women don't realise their health issues are caused by low oestrogen.  Years ago, my partner's grandmother told me she has no problems with the menopause and then went on to list a whole load of second phase menopause symptoms.  She didn't make the connection and didn't realise they were caused by low oestrogen.

I really don't think the NHS can handle menopause care unless it's prescribing the cheapest, bog standard HRT.  That is what my niece is instructed to do.  They can't deal with problems or provide flexible dosing, I'm afraid people have to work it out for themselves, go to a private specialist or go without.  NHS Menopause clinic are over subscribed with massive waiting lists and from what I've seen on here, they are very by the book and inflexible.  My sister's NHS care with the menopause and osteoporosis is virtually non existent and she has been left to fester on a virtually useless form/dose of HRT.

It sounds like you have the same low oestrogen migraine auras as me Dandelion.  To be honest, I'm pretty pissed off that the medical professional know so little about this menopause symptom.  It's fairly unusual but they should be aware of it.  There is plenty of BS about migraine auras being caused by high oestrogen or oestrogen fluctuations but very little about menopause induced brain stem auras.  God knows how much time I've spent over the past 21 years (when the migraines first struck) working all this out for myself.

By the way I'm 64 now so getting into old bint territory!

[Wrensong]

Dandelion, it's good that your doctor is open-minded about dosing while you remain symptomatic & I hope this means you will eventually reach a point where you feel good enough.

she says menpause is all in the head

I think it can be impossible for anyone who's not had a bad experience with menopause to really grasp how life-wrecking it can be for some & how individual our responses can be.  I certainly could never have imagined what it can do before it happened to me.

What side effects did you get from the oestrogen?

For me, higher doses exacerbate pre-existing slow digestive transit (a consequence of 2 other chronic conditions, 1 endocrine, 1 anatomical) to an unmanageable degree.  I also retain too much fluid on higher oestrogen, mostly abdominally & the combination of these 2 side effects puts very uncomfortable pressure on pelvic organs, mechanically compromising bladder & bowel function.  I'm very slight, with size 6-8 hips, so don't have a lot of room laterally to accommodate a high degree of abdo bloating & need to avoid it, having already had pelvic floor surgery.

Although they tend to improve the depth of my sleep between awakenings, higher E2 doses also worsen the intensity of the horrible fight or flight cascade that comes with the extreme overheating I still get every night, meaning harder, faster palpitations, nausea & irrational, helpless panic/fear off the scale, often leaving me far too alert to get back to sleep.  The combination is not only dreadful but together with chronic insomnia must take a cumulative toll on the body over the years (now in year 20 since this began) & that's a worry.

On higher doses these days I also get what I can only describe as a sense of systemic toxicity, an overly drugged, sluggish feeling, with a tell-tale sallow tint to skin that looks as unhealthy as it makes me feel.

I have an adult lifelong history of migraine with aura & on higher E2 there is also often a sense of the more subtle aspects of this condition ongoing in the background.  Ditto when my body is adjusting to a change of dose.

I should stress my medical history is complex & unusual (more to it than I've touched on here) & this almost certainly has a considerable bearing on how my body reacts to HRT that will not be directly comparable to other women, so there is no need for anyone to worry the same might happen to them.
Wx

[Wrensong]

a longstanding member indeed,  thanks for pointing that out Wrensong lol!

Oh Kathleen, but surely it's a good thing to be among the longstanding members who've contributed a lot?  There have been many I can think of over the years the sight of whose names always makes me want to stop & read what they have to say.  If I'm not disciplined I get hooked in & spend too much time on the forum when I should be doing other things.  One reason I look at it less these days