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[Dotty]

Hi I’m writing this on behalf of a good friend of mine. She’s 71 and has been on HRT for about 8 years.

She started on Indivina 1mg which worked for a while and then symptoms came back so she went into Indivina 2mg. This worked fine for a few years before symptoms came back. She went onto Oestrogel and 5 pumps worked for a couple of years . Symptoms came back so she switched to patches 125 strength. Again all was ok for a while and then symptoms came back. She went onto 3mg oral oestrogen and again this worked for about a year. She was put onto Lenzetto 3 pumps and that’s been ok for about 6 months but symptoms have come back again.

When the symptoms come back they are quite debilitating… not just a few hot flushes. Her GP has said she’s on too high a dose and has told her to reduce. She’s done this but is now feeling even worse.  She’s also tried anti depressants which did nothing.

Can anybody shed any light onto why each HRT stops working ?

Thanks for reading.

[bombsh3ll]

That's puzzling given she has tried different routes and products.

It could be down to multiple factors, tachyphylaxis (unlikely on low/standard doses), changes in weight/body composition, other medications or conditions.

A blood test to check absorption would be helpful.

I would recommend seeing a specialist as this is likely to be outwith the scope of practice of a GP to deal with.

[Dotty]

Thanks, bombshell.

I can’t understand it either. Body weight hadn’t changed and medications not changed.

Oestrogen results on 5 pumps of gel and 125 patch were 190 when the symptoms came back. She’s just had another blood test but it was taken out of the arm where she puts the Lenzetto and it was 520. One GP said it was ok and another said it was too high.

A specialist put her on Lenzetto. Specialist suggested the next thing would be to stop hrt for a month and then start again.

[Dotty]

Can anyone else help?

[Mary G]

Dotty, I'm sorry to say Lenzetto is a great, user friendly product but it's far too weak.  On 3 sprays I barely managed to get to the late 200s in pmol.

I find it incredible that your friend was told to reduce the Lenzetto dose.  It tells me her doctor doesn't know what they are doing which is pretty scary.  It seems unlikely this GP will offer oestrogen blood tests or be capable of prescribing the right type of HRT at the right dose. 

It sounds like your friend is a very poor absorber.  What type/dose of progesterone is she taking?  If it's too high, it will completely drown out the benefits of the oestrogen, particularly with something as weak as Lenzetto.

Can she afford to have a proper assessment and consultation with a private menopause specialist?

[Dotty]

Hi Mary G thanks for replying. She has had blood tests a few weeks ago and the oestradiol level came back at 520 but she had it drawn from the arm which she uses the Lenzetto on so I would doubt the result.

She’s using Gepretix 100….used to be on Utrogestan 100.

She has seen a private menopause specialist previously and this specialist told her she needed to decrease the oestrogen!

It was an NHS menopause specialist who put her on Lenzetto .

[Mary G]

Dotty, I think this is one for the Newson clinic. 

Your friend has a good level of oestrogen but if she had only just applied the Lenzetto, it might have artificially raised her levels.

Other forms of medication she is taking could make HRT less effective too but I think she needs to see a specialist and not the same one as before.

Has this been going on since she started HRT 8 years ago?

[Dotty]

Hi Mary G, yes it’s been ongoing. She’s ok for a while and then symptoms have come back. This has happened first on Indivina; then Oestrogel ; then patches; then oral oestrogen and now Lenzetto.  She’s ok and then symptoms come back, so she’s changed to a different type and is ok for 6 months to a year and then symptoms come back.  It’s as if her body gets used to the type of hrt or stops absorbing so she changes to a different type and it happens again after 6 months to a year.

Previously when she has felt bad her levels have been 190, so I think this Lenzetto reading is incorrect. She had her levels tested when she felt good last year and they were 379.

[Mary G]

It's looking clearer now Dotty.  I think your friend has absorption problems and probably needs to mix and match different products ie patches and Oestrogel and even oral oestrogen too.  Quite a few women on here do that and I think joziel might be one of them.

I still think it's worth her seeing a menopause specialist even if it's just a one off.   I would recommend she phones first to explain her problem, sound them out and guage how receptive they are.

[Dotty]

Thanks Mary…hadn’t thought of using two products. I’ll let her know that idea.