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[Moog77]

Hi everyone

I’ve just had recent blood tests where my oestrogen measured 150 pmolI’m on 2.5 mcg of sandrena gel. The ‘specialist’ I saw said that is quite a high amount of HRT and I should lower to 2mcg?? This is based on bloods taken at 8am in the morning and that I hadn’t put my gel on yet.

This seems counterproductive to me? I’m massively symptomatic at the moment  am not sure what’s causing it - recently tried to wean off an antidepressant which is quite unpleasant and all hell has broken loose. I was also on testosterone for 5 weeks prior but she advised coming off that too as my Testosterone was 1.13 and my FAI was 1.1. It’s been quite hard to unpick what is causing what but I definitely have hormonal symptoms - sore boobs and cramps and terrible stomach issues. She said that will be the testosterone causing that. But it feels like a creep of symptoms pre HRT to be honest.

It really felt like a bit of a waste of time and money but would appreciate any advice here.

[bombsh3ll]

That's nonsense, 150pmol/L is below even the NHS threshold of 250pmol/L for bone protection.

Also there's no reason to come off your testosterone.

This doesn't sound like someone particularly knowledgeable about hormone therapy to be honest and I would see someone else.

As you are having blood tests and have had albeit brief access to testosterone I am guessing this is a private "specialist" which are often GPs looking to cash in on the menopause movement with no additional training and limited clinical experience in treating menopause.

Just cut your losses there and seek out someone whose approach aligns better with your needs rather than the "lowest available dose, shortest time and for heavens sake no testosterone" school of menopause.

[Moog77]

So I’m not going crazy? She said this was a snapshot in time and likely my own levels of oestrogen if I hadn’t put my gel on that day so therefore quite good. The comment about a high dose of Sandrena gave me a bit of a pause. She mentioned I might need more than the 200mcg of utrogestan that I take cyclically if I was to be on such a ‘high’ Sandrena dose.

Urrrgggh! I’m going on holiday in 10 days and I can’t go feeling like this.

[Cassie]

 I agree with BS that sounds like she is clueless.

[bombsh3ll]

Whilst a level of 150pmol/L can sometimes be seen transiently during menses in a healthy woman, it is not a desirable level to have across the cycle as it is unlikely to protect your bones and may not even be sufficient to control menopausal symptoms.

The problem with gel is that measuring blood levels is pretty meaningless (which a specialist should know) as it peaks and then drops off rapidly.

If you are still perimenopausal, suggested by the cyclical use of progesterone, endogenous levels can be fluctuating in the background as well.

Have you considered oral estradiol or patches? Both of these can make for more stable delivery.

As to whether your progesterone is adequate, this is better determined by the absence of unscheduled bleeding, and ideally a lining scan every now and again, than simply saying you are on X milligrams of estradiol so you need X dose of progesterone. This is reductive, over simplistic and takes no account of individual variation in absorption and metabolism of hormones, leading to overtreatment of some women and undertreatment of others.

[Moog77]

I started off on patches and felt really quite well but then there was an issue with getting estradot a while back so moved to gel.

Felt very well on oestrogel until all the faffing with the bottles started. Back to patches but could not get them to stick and moved to Sandrena. And here I am.

I wonder if patches and top up gel would work perhaps? I do well on patches right enough but had so much issues with them sticking the last time I tried. Looks like I need yet another consultation privately *deep sigh*


I didn’t do very well on the BC pill I have to say so nervous about tablets.

I don’t have any bleeding so hopefully all OK there.

[bombsh3ll]

It would almost certainly be the progestin that upset you with the birth control pill.

Additionally most birth control pills contain ethinylestradiol rather than body identical 17 beta estradiol.

I wouldn't be scared to try oral estradiol - I see so many women struggling with subtherapeutic, unreliable and high maintenance transdermal options needlessly.

Especially if this is just a temporary measure until estrodot comes back.

Personally I will only ever use oral unless I have a health issue that forces me to use transdermal, and even then it would be patches not gel.

I used patches for IVF and some tips I learned for keeping them on were cleaning the skin first with alcohol to strip the natural oils, using heat to bond the patch eg hand warmer or hairdryer, and applying a square of hypafix over the top.

They still itched but I could get away with at least one quick shower without losing the patch.

[sheila99]

I agree with everyone else, ditch this specialist and find someone more knowledgeable who actually wants to help you. Many do video appointments now so you don't need one you live close to.

[Moog77]

This is v helpful.

I have asked for another bash at patches. I’ll stick with that for 3 months and certainly utilise the alcohol wipes and tagaderm. I suspect I had a couple of duff boxes of patches when they wouldn’t stick.

If no joy then definitely going to try the tablets.

[Moog77]

Also because I was I such a state I did reduce to 2mcg of Sandrena last week because I was desperate to feel better. I realise that was a mistake so bumped back up to my 2.5mcg a couple of days ago.

I think my hormones are all over the place. Hope it smooths out a bit now.

[Konijntje]

For me, patches give a much more uneven delivery than lenzetto spray. Have you tried dividing your gel dose mornings and evening? That is what I did with the spray. (I got a rash from the patch, but did manage to do ok-ish when I cleaned my skin before sticking it on. I do wonder if the uneven delivery was because of my skin reaction).

[Mary G]

I had terrible problems with patches.  They didn't stick properly, they were unsuitable in a hot climate and I wasn't getting anything like enough oestrogen out of them hence lack of symptom control.  I didn't like physically having a patch stuck to me either and I was very aware of it being there.

I also split my Oestrogel dose by 12 hours using one pump in the morning and one at night.

I agree that 150pmol oestrogen is ridiculously low so god knows why your specialist said you should reduce your dose.  That doesn't make any sense at all.  I take it you definitely mean pmol and not pg/mL because that would make a huge difference.  150pg/mL is 550pmol but that is not really too high either.  Perhaps the specialist is confused?

[Moog77]

Definitely 150pmol.

Ive went back up to 2.5 sachets and will stay in that just now until I get back from holiday. I just want some kind of stability. Yeesh.

Tapering down ti a v low dose of antidepressant hasn’t helped - and apparently I shouldn’t have been really cutting or quartering the tablets as they aren’t made to be cut up like that so I’ve been probably bouncing around dose wise daily which was manageable until the last jump down. Got to be careful on these meds.

[Dandelion]

Hi everyone

I’ve just had recent blood tests where my oestrogen measured 150 pmolI’m on 2.5 mcg of sandrena gel. The ‘specialist’ I saw said that is quite a high amount of HRT and I should lower to 2mcg?? This is based on bloods taken at 8am in the morning and that I hadn’t put my gel on yet.

This seems counterproductive to me? I’m massively symptomatic at the moment  am not sure what’s causing it - recently tried to wean off an antidepressant which is quite unpleasant and all hell has broken loose. I was also on testosterone for 5 weeks prior but she advised coming off that too as my Testosterone was 1.13 and my FAI was 1.1. It’s been quite hard to unpick what is causing what but I definitely have hormonal symptoms - sore boobs and cramps and terrible stomach issues. She said that will be the testosterone causing that. But it feels like a creep of symptoms pre HRT to be honest.

It really felt like a bit of a waste of time and money but would appreciate any advice here.

150pmol is well low.
You might be a poor absorber, so, no matter the dose, if you're only getting so much into your bloodstream, not enough is there to do it's job.
This happened to me. I'm increasing along with blood tests to show my crappy absorption  Levels are going up for me, but it's still a bit low I think, I'll see when I next get tests and see Dr in September.
Studies show 400pmol is where it's at https://www.drlouisenewson.co.uk/knowledge/understanding-hormone-levels-in-your-blood for healing.
There is no real ok level for testosterone, everyone is different.
Nowadays, we are guided more by symptoms.
Your symptoms sound, to a lay person like me, like they're all due to low oestrogen.
You're not wasting your time and money, it's just that some Dr's are working to what we now know as the "old skool ways" based on data from the WHI study of 2002, which we now know to be flawed.
These Drs genuinely believe they are doing the right thing, it's not their fault as such.
Can you share this with your practitioner, see another practitioner or another clinic?

[Mary G]

Dandelion, I would say these specialists owe it to their patients to be up to speed and know the new guidelines that have been around for years now.

Those two deeply flawed studies were debunked and busted wide open years ago so nobody should be guided by them now.  Anyone who is still influenced by them is 20 years out of date and women are suffering because of it.  It's serious stuff.

The late Professor Studd, Professor Panay and Dr Louise Newson are the menopause experts who people should be guided by and they have written plenty of good material that is worth reading.