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[bombsh3ll]

Your estrogen is really low and you have not mentioned any androgen replacement.

You really need to get much more aggressive about this, it is harmful putting young women on grandma's dose of estrogen and hoping everything will be OK.

Is there any reason you can't take oral estrogen?

It is generally easier to achieve a therapeutic level within the product's licensed dose, for multiple reasons, vs patches, which often struggle to provide adequate levels and providers particularly within the NHS can be reluctant to increase beyond 100mcg.

Additionally where someone under 50 is having difficulty accessing therapeutic replacement due to their clinicians not understanding the implications of undertreatment, the combined oral contraceptive pill taken continuously can be a better option for bone protection, because it provides a more age appropriate dose of estrogen than treatment designed to palliate vasomotor symptoms in much older women.

All being equal, in an Idea world, yes transdermal estriol is metabolically more favourable, but the elephant in the room is subtherapeutic prescribing, hence pragmatically it can be better to use the pill, as this takes dosing out of the hands of the reticent prescriber.

[pineneedles]

Thanks Bombshell ... I do need to get more assertive about this, but it's hard, particularly when I have to wait for so long for each next appointment and in the end I just end up feeling grateful for having been seen by a doctor at all 

I was told in my 20s I shouldn't be on the combined pill for contraception because of having family blood clot history, and when I asked about this at the initial menopause clinic appointment they said it was the same risk for oral oestrogen supplement but transdermal was much safer.

No androgen replacement tried yet. I wanted to get to an OK level with the oestrogen in the first instance.

I can afford to go private if I need to (for as long as I don't get so fed up at work that I just pack it in, that is! It's borderline some days...). Was keeping that as a future option, but maybe it's something I need to move faster with.

[lizzy76]

Hi Pineneedles,

I'm in a similar situation as you with meno in mid 40s and dexa scan showing osteopenia.

Have been on evorel 50 for maybe 6 months along with testosterone. Blood test a couple of weeks ago showed oestradiol at only 123.21 which was surprising as I expected it to be higher. I have since gone up to 75 but I'm wondering if I need to go higher or try a different oestrogen.

I'm doing weights but it seems as if oestrogen is the thing that is going to make the most difference. I'll have another blood test at some point but wondering whether to just wang it up to 100 in the meantime.

[bombsh3ll]

The difference in thrombotic risk is much lower than commonly portrayed, of the order of one extra clot per 5000 women over a year.

It can be argued that a therapeutic dose of oral estradiol is safer than the long term health risks of an insufficient dose of transdermal, in the same way that a trolley full of healthy, nutritious supermarket brand food that can feed your family for a week is better than a small basket of organic grass fed produce that will last a day at most.

However if you have the means to go private I would consider this a very worthwhile investment in your health. You only have one body and one life. Don't waste it waiting for NHS appointments, being grateful for pitiful estrogen doses and no testosterone, whilst your bones lose critical density.

[Mary G]

I agree with bomb, don't hesitate to get help privately if you need to and don't bother to wait for an NHS menopause clinic appointment either, the waiting lists are horrendous and women are often waiting for over a year. 

My sister has osteopenia and has been using Evorel conti for well over a year but she had another DEXA scan and it hasn't shifted the dial at all.  It's too low a dose (50 mcg oestrgen) and she's not getting any meaningful help from the NHS.  She had a telephone appointment with a dangerously useless specialist who told her HRT wouldn't help which is complete BS.  She's tried various different types of medication for osteoporosis but they made her really ill with terrible side effects.