Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[Summer25]

Hi,

I am 2.5 years post menopause, diagnosed with adenomyosis, was given zoladex injections only took 2 as they put me into depression and have had crippling anxiety since, also hardly any sleep and night sweats. My GP put me on 50mg Evorel and 100mg Utrogestan 3 weeks ago, have had a few normallish days but I am not sure it I have been getting estrogen dumping, after a shower Sunday and last night I noticed I could not get to sleep and was wired all night, googled it and found it is a thing where the patches get hot and dump estrogen in the body more. I woke in the night and ripped my patch off and things calmed down a bit. Put a new one on this morning and have had bad anxiety all morning.

I also got some bloods done and wondered if anyone can tell me if I need to come off the estrogen? I think they are right but it seems awfully high

FSH - 19.8 IU/L
LH - 13.9 IU/L
OESTRADIOL - 1349 pmol/L
TESTOSTERONE - 2.41 nmol/L

FREE ANDRONGEN INDEX - 3.63
PROLACTIN - 515 mIU/ L

The note also said 'Your oestradiol level is above the usual target range for hormone replacement therapy. This may be appropriate depending on your symptom control and the type of HRT you're on, but I’d recommend sharing this result with your HRT prescriber so they can assess this in the context of your clinical picture.


If anyone can please help me and I think my estrogen may be too high now? Also I do know that coming off zoladex can cause anxiety and panic attacks so cannot just blame how I am feeling on HRT.

Thank you

[joziel]

The thing is, your FSH is high. Which is your body crying out for estrogen....

I would not overreact on the basis of one blood test, I would run another test. Test on day 2 or 3 of a patch change. Make sure the patch is not somewhere it is getting baked in the sun in this hot weather.

How do you know that you are post-meno if you had Zoladex... ?

It is hard to fathom how a single 50mcg patch can give you levels of 1349pmol. By comparison, I'm on 300mcg (3x 100mcg patches) PLUS 6 pumps of gel (on the last test) and that was getting me to about 850pmol. We all absorb differently, but that would be something of a record amount of estrogen to get from a single 50mcg patch.

It is much more likely that you are not really post-meno, and that your ovaries are still making (erratic and irregular) estrogen and you happened to test during one of these peaks. With an FSH that high, anxiety, night sweats, insomnia etc - you are in need of probably more estrogen, not less. (Weirdly, if you take a small amount but not enough, you can end up feeling worse than when you had none at all - that was my experience on 50mcg. I also felt wired at night on not-enough.)

If I were you, I would not change anything at the moment but would re-test again to check that result.

[Summer25]

Oh so it is more the FSH that I need to look for?

Ok I am going to run another test next month, I am going to get estrogel prescribed to me, the GP said 2 pumps but do you think I might need more

I am just assuming I am post meno as I havent had a period for 2.5 years so guessed I was, I was hoping that my own hormones would kick back in and I wouldn't need HRT?

I thought that having adenomyosis means you are estrogen dominent? therefore you have too much estrogen? Wow you are on a big dose, I did think that the dose was big from the patch considering I have only been on HRT 3 weeks.

Oh yes possibly I am not post meno and ovaries are erratic. I have just added 0.25 patch to take it up to 75mg of evorel to see if that helps, I just dont want the anxiety to go through the roof again on the extra I have added, I mean the zoladex would have shut it all down is that right? Maybe that is why I feel wired at times.

I am off sick from work right now and need to get this anxiety sorted so I can go back

Do you know what the FSH should be then?

[Summer25]

jozel,

also if i am not post meno I do not need to take utrogestan constantly do I?

[joziel]

No, it's not just the FSH alone. But that high FSH result does not tally with an estrogen result of 1350pmol.

For example, my estrogen is 850pmol (which is pretty high) and my FSH is consistently 0.01 or something (LH too) - very very low.

The FSH is your pituitary in your brain 'telling' your ovaries to make more estrogen because more is needed. If E is high, your FSH should be low because your brain isn't going to be demanding more estrogen. (As with my results.)

So that's all to say your FSH suggests you are not in a state of constantly too much estrogen... Your FSH is usually around 4-ish. But on HRT if you take a good dose, it can go very low like mine does and that's fine. It just means my body is getting it all from HRT. But if it is above 4, it would suggest you're not getting enough from one source or another.

We all absorb different products differently. I can't see a reason to switch to gel personally, in your situation. The only reason to switch would be if you were not absorbing the patches okay. Your estrogen result doesn't suggest that, at least. Besides, the gel is a faff and a pain in the ass and you have to wait for it to dry, it can transfer to pets and other family members - plus it is not as stable in terms of delivery as patches are.

There is no such thing as being 'estrogen dominant' - only progesterone deficient. And even if you once had very high estrogen in your life, there is no evidence that you will continue to always have high estrogen. Menopause is a low estrogen state which is permanent. You are not going to be 'estrogen dominant' in menopause....

Whether to take utrogestan continuously doesn't really have anything to do with whether you are in post-meno or not, it is down to personal preference and whether you want to have a bleed and also it is down to whether the dose of estrogen you are taking (or making) is high enough that you NEED to schedule a bleed in order for it to come out when you plan it to - instead of randomly, worrying the doctor and seeing you referred for investigations unnecessarily. If your E is at 1350pmol (whether through HRT or your ovaries) you do need to schedule a bleed IMO, because that level will be causing uterine build up - which needs to come out in a scheduled way.

That just means you stop the utrogestan on day 26 of your cycle. It can then take about 5 days for the bleed to start and then you need to allow it to come out over about 4 days. You can then restart it, on about day 5 of your cycle, if you want to be almost continuous. Or you can wait until day 16 to re-start it, if you want to be sequential/cyclic. If you are on cyclic, you should be taking 200mg from day 16-26 - so it is taking it for half the month, but at double the dose. You can also take the same P vaginally for better absorption and protection of the endometrium.

[bombsh3ll]

Your FSH doesn't suggest overtreatment, and it is virtually impossible to get that level of estradiol from a 50mcg patch even if you put a blow torch to it.

You probably just ovulated.

Estradiol levels can go much higher than that with ovulation, mine used to be around 2500pmol/L and when things start to go haywire in perimenopause, you can even have what's called a LOOP event where two ovulations occur in the same cycle.

If you have been on zoladex this implies you are not postmenopausal as it has no indication in postmenopausal women, however it can induce a temporary "chemical menopause" which may now just be wearing off depending on how long ago you last took it.

However if you are unhappy with your current treatment symptomatically and feel that your absorption from the patches is inconsistent, then it is worth looking at alternative treatment options for that reason rather than based on a single blood test.

[Summer25]

Thank you Josiel for your answers

It is all very complicated, my pitauitary gland was switched off when I had zoladex throwing me into this chemical menopause chaos and now my mental health is suffering badly.

When you say take a good dose of HRT how much are we talking, I have upped it to 75mg patch, so that will not get rid of the anxiety is that what you are saying?

Gel was offered to me by the GP so I said I would try it, I agree the gel is a faff which is why I opted for patches. GP said it was easier to add or cut down the gel.

So basically with my adenomyosis I was progestrone deficient, tried different progesterones and they just made me depressed, maybe utrogestan is also making me feel rubbish too.

So if I have not had a period for 2.5 years why would I not be post menopause? So you would recommend a bleed then, I thought it was take 25 days continuously and have a 3 day break not 5 days? I have been taking vaginally and am on day 22

[Summer25]

bombsh311

So it is fine to carry on with hrt, would you suggest going up like i have to 75mg of patch?

I had 2 injections of zoladex and had to the last one on May 16th and still suffering anxiety, I understand that it can take months to fully get out of the system but surely most of it is out now so it is my own hormones that are unbalanced causing the anxiety?

I am happy with the patches it is just we all want results overnight, my GP suggested the Gel, thank you I will not base my results on the blood test just my symptoms

[joziel]

"When you say take a good dose of HRT how much are we talking, I have upped it to 75mg patch, so that will not get rid of the anxiety is that what you are saying?"

I wouldn't focus on doses at all, I would focus on taking whatever you need to take to treat symptoms and to get you reliably into the 400pmol + range. Reliably meaning - across multiple blood tests taken at different times, all showing you are consistently over that level. The maximum licensed dose is 100mcg for patches or 4 pumps of gel and you should easily be able to go up to that via your GP. If you need more, you will need to go private to a menopause clinic like Newson Health.

"So basically with my adenomyosis I was progestrone deficient, tried different progesterones and they just made me depressed, maybe utrogestan is also making me feel rubbish too"

There is only one progesterone, which is utrogestan. It is the only body identical progesterone that exists. Anything else you would have been given, would be a synthetic progestin. Which can have negative effects on mental health, increase the risk of breast cancer and poor lipid profiles, increase cholesterol, increase the risk of hair loss and loads more besides. Some women do have negative side effects to utrogestan as well, but from what you've described, your symptoms are far more those of estrogen deficiency than progesterone related.... (hot flashes, anxiety)

"So if I have not had a period for 2.5 years why would I not be post menopause? "

Because you had Zoladex which turned off your own cycles for an indeterminate amount of time.

"So you would recommend a bleed then, I thought it was take 25 days continuously and have a 3 day break not 5 days? I have been taking vaginally and am on day 22"

You can do that, that is called the 'old' continuous regime. However if you are taking enough progesterone (which you are not), it will take at least 5 days usually after you stop the progesterone for a bleed to start. If you begin taking it again before the bleed has started, you are really just opposing the bleeding and not letting it happen fully. A tiny 3 day break might have been enough for micro estrogen doses on the original poor HRT regimes as you'd just need to take the pressure off with a little bleed, but it's not going to be enough if you are taking enough estrogen or if you have your own estrogen at 1350pmol....

By the way, my hunch is that starting HRT after you have suppressed your own hormones for a while can sometimes cause some adjustment and weird wired/hyper feelings especially at night.

[Summer25]

joziel I appreciate your feedback, its all such a mindfield.

But surely the higher dose you would get estrogen into the body quicker or does that just depend on how well each person absorbs it. I could wear the patch and add some gel in but will that make the anxiety worse?

Yes the other progesterones prescribed by my consultant I lasted on them 2 weeks as they just made me feel numb. Yes I feel mine are more estrogen related.

The zoladex turned off my cycle for 2 months, surely my own hormones will be kicking back in by now as my last injection was May 16th? Or maybe they were low in the first place for me to suffer this bad with anxiety.

Ok I think I need a bleed so I will do that this month and see what happens, sorry confused with the figure of my own estrogen at 1350pmol surely I shouldnt be suffering as it is over the 400pmol range?

I get that maybe I am not going to have an easy ride feeling better, it feels like I am living in a nightmare at the moment, I tend to get the wired feeling at bedtime

[bombsh3ll]

Just because your estradiol was high at that one snapshot in time doesn't mean it is consistently at that level, especially if you just happened to have ovulated.

Also it can be fluctuating levels that cause discomfort in some people more than simply being deficient.

Whilst I can't advise you regarding what particular dose you need, if I were using patches - which I don't plan to, I prefer oral treatment and currently take a combined pill, but I have used patches during IVF - but if I were postmenopausal and had to use transdermal for medical reasons, I personally wouldn't use less than a 100mcg patch and may require more as I intend to keep my estradiol above 400pmol/L for optimal bone, cardiovascular and cognitive health maintenance.

[Summer25]

I understand what you are saying.

Surely my own hormones are now kicking in from stopping the injection?

So i upped the patch to 75mg yesterday, wired at bedtime, distirbed sleep had about 5 hrs, woke with the dread/doom feeling, anxious, jittery & just want to get away from all this.

I am so unsure what to do, my body is not liking all this, i have had better days & then i feel awful again.

Maybe i should stop hrt

[joziel]

Summer, what you're experiencing is exactly what I experienced when I first started HRT. 3 weeks after beginning it, on only 50mcg patch, I began to feel really wired, jittery, and have inner tremors at night and insomnia. I would startle awake if I even began to sleep and any sleep was very light.

I concluded that HRT was 'causing' this as it didn't happen before. I stopped HRT for 6 months. None of it got any better. I re-started it. None of it got better or worse. I was stuck. So instead we increased estrogen.

I also came from a low hormone state having been on desogestrel before starting HRT. As you were, on Zoladex.

Which is all to say - it is not as simple as estrogen 'causing' your symptoms. These kind of symptoms can be from the HPA axis getting disrupted by the sudden reintroduction of hormones - and your body being stuck in a state of fight or flight, which can take some while with stable hormones to get out of. (It has taken about 2.5 years for me.) Stopping the hormones is unlikely to help and will lead to low estrogen symptoms returning. The Zoladex is likely wearing off, but you are 52 so you are now in the usual rollercoaster of peri where hormones can be high and then low.

Firstly, you need to figure out if you consistently have high estrogen or if that was a random weird result. Like bomb says, just because you got one single high result doesn't mean you always have high estrogen. During peri your levels can be all over the place, causing these symptoms. You can have 1300pmol and 2 hours later, you could have 100pmol. This is why higher levels during peri can help, because they override the fluctuations and provide you with consistency.

The symptoms you describe (especially the dread/doom feeling) are typically low estrogen. You need to repeat tests, paying for your own if necessary privately, to see what your levels are.

You also need to take supplements to help reduce your cortisol at night. Seriphos is a good one. Melatonin. GABA. l-theanine. Apigenin. These don't work immediately. You can also do a 4 point saliva cortisol test, but it will likely tell you that your cortisol is high at night. And it is high because when we lose sex hormones, our bodies make more cortisol and adrenaline to try to compensate....