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[Banana11]

If you are feeling irritable, tired and achy and your bloods are all normal, how do you know what to increase or add?

[bombsh3ll]

That would depend on what you're already using, what blood tests have been done and the results.

Being told all results are "normal" isn't always helpful as it is "normal" for menopausal women to have virtually no estrogen and often low testosterone too, however few people would consider that situation desirable.

Other medical issues such as anaemia, thyroid, vitamin deficiency etc should also be excluded.

[Banana11]

Hi, all the ones you mentioned are fine.  I’m on Everol 50 and Merina coil. 

[CLKD]

When did U last have VitD and thyroid function blood levels checked and do be aware that GPs won't do a full thyroid panel even when patients continue to complain of symptoms which may be related. 

What R your periods up to?

[Banana11]

Clad, periods have stopped since having the coil a few months ago.  Just occasional spotting.  Vit D and thyroid results are fine x

[bombsh3ll]

You are on a relatively low dose of estradiol, certainly if your own production is low or none existent, 50mcg doesn't usually result in the best quality of life achievable for most women, however this would be more complicated if you still have some endogenous ovarian activity.

When you say the results are fine, have you actually been given the numerical values?

Also if you are not on any androgen supplementation it is likely that testosterone is also low (a blood test is typically done to exclude treating someone who has a high level at baseline however this is as rare as hen's teeth) and certainly could benefit the symptoms you describe.

I personally would ensure a therapeutic level of estrogen either before or alongside adding in testosterone. Otherwise you are just taking really expensive estrogen as the body prioritises aromatisation of testosterone to estradiol in the setting of hypoestrogenism. 

[Banana11]

I spoke to the doctor yesterday about increasing Everol 50 to 75.  She said at my age 57, I should be thinking of reducing not increasing the Everol.  As I work in education and have had the six weeks holiday, she thinks I should go back to work first and see how I got on before any Everol increase.  I also thought that maybe I increase my B12.  Any words of wisdom? X

[sheila99]

Get a new GP who won't just fob you off. The NHS are unlikely to test your oestrogen levels so I would do I privately (many options eg medichecks, randox) and decide what to do based on the results.

[Banana11]

Sheila99 - good idea!

[Mary G]

Why did she think you need to reduce your oestrogen dose based solely on age?  Did she explain her thinking behind it or was she just towing some imaginary line?  It sounds like complete nonsense to me and she is wasting your (and NHS) time and giving you the runaround.

I touched upon this the other day, I'm getting a real sense of push back on NHS HRT prescriptions from reading stuff on here.  My advice is to get hold of some extra patches online to top up or go to a private menopause specialist and get some proper advice from someone who actually knows what they are talking about.

This is definitely getting worse and there seems to be an anti HRT culture creeping in.

[bombsh3ll]

There is absolutely no evidence supporting the practice of arbitrary reduction in estrogen dose at a given age or duration of use.

Whilst this is often done to women without any discussion or their informed consent, it tends to result in harm rather than any benefit, and the lost estrogen is quickly replaced by other medications such as painkillers, sleeping pills, antidepressants, anticholinergics for bladder symptoms (which are a class A dementogen) and bisphosphonates or metal pins for osteoporotic fractures.

Guidelines recommend that as with any treatment, the lowest EFFECTIVE dose of estrogen be used, and that no age based cut offs should be applied.

I would only change my treatment if there was a clinical reason to do so, that related to me as an individual, not due to fear or ignorance on the part of the clinician.

[Hurdity]

I spoke to the doctor yesterday about increasing Everol 50 to 75.  She said at my age 57, I should be thinking of reducing not increasing the Everol.  As I work in education and have had the six weeks holiday, she thinks I should go back to work first and see how I got on before any Everol increase.  I also thought that maybe I increase my B12.  Any words of wisdom? X

My words of wisdom in response to: "She said at my age 57, I should be thinking of reducing not increasing the Everol." - absolute rubbish!!!!

I am 72 and I am on Evorel 75. I was on 50 mcg patch for years (since  my 50's) but perhaps my absorption is not so good these days due to age? I increased to approx 62.5 for several years but got fed up of cutting off a tiny bit of patch as they started to uncurl along the cut edge so now I put on the whole patch and I feel great!

So here's an idea - following the others advice - that there is no recommended cut off age, if the GP can accept that - request that you try 62.5 but this can be achieved by cutting a bit off the 75 mcg - and before you know where you are -  you could put on the whole patch.

I mean you're only 57 - I only started HRT at age 54!! 50 mcg worked well for me because I was still peri-menopausal and producing my own oestrogen.

The other possibility is that if you are completely new to the coil, some of those symptoms could be due to mild progestogen intolerance - the amount of progestogen released into the bloodstream gradually decreases over time but since the coil is designed to last around 4-5 years for HRT purposes then this is a long time.

The good news is that for some women, increasing oestrogen can sometimes counter the negative effects of progestogens - not as a "balance" but somehow can "drown" them out or mask them to some extent ( not very scientific I know) - so another reason to try an increase....

Good luck with your endeavours

Hurdity x

[Banana11]

Thank you for all of your comments.  I was on Everol 50 Sequi +25 Everol before I had the coil.  I then went to Everol 50 with the coil. X