Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: donnacrichton on December 28, 2014, 07:09:31 PM
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Hi been trying to get a dose of estrogel stable. Not sure if I'm too high or too low. Been to see consultant who thinks I am still low. On 5 pumps just now but still got flushing tingling & palpitations. He says go as high as 6 but scared I'm already high as symptom's so similar. Got anxiety but keeping it under control with anxiety management. I am splitting dose every 12 hours no wondering if would be better to take 5 together as might not be getting optimum dose? Puzzled anyone else on this high estrogel dose and do you apply it all at once ?
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Hi
Im 55 and been using 4 pumps, 2 morning 2 eve. My new consultant has told me to reduce, so I'm using 3 pumps but find I'm not sleeping well and sweats day and night.
Will try to carry on but I wonder if Oestragel tends to not be absorbed well with some women.
Make sure you always shake the bottle as it tends to get weaker the lower it gets!
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I know it is not the best marker, but can you get your estrogen levels tested? Better than guess work and would reassure you one way or the other x
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Getting the dosage right is tricky. I think I've said elsewhere recently that HRT usually aims to average out the oestrogen dose over the whole menstural cycle and I don't know what the symptoms would be if they remained at the ovulatory peak for the whole month.
The only information on very high levels that I've found is from Prof Studd's site where some women, particuarly sometimes with those on oestrogen implants (I'm not sure if these are still available?) attain levels higher than you would expect normally and the oestrogen ceases to work. I don't think this occurs with gel though as it would be difficult to apply this much - but I don't know actually. Only blood tests would tell. You can read about it here )scroll down):
http://www.studd.co.uk/implants.php
I do understand that it is more difficult to get a steady dose of estradiol from gel than from patches because absorption of gel is more dependent on the area where it is applied. From what I recall the area is crucial because the estradiol needs to be absorbed before the gel dries, but if it dries too soon ( ie if spread too thinly) then less is absorbed ( which is counter-intuitive). This is what the SPC for Sandrena says:
"Sandrena is an alcohol-based estradiol gel. When applied to the skin the alcohol evaporates rapidly and estradiol is absorbed through the skin into the circulation. Application of Sandrena on area of 200-400 cm2 (size of one to two hands) does not affect the amount of estradiol absorbed. However, if Sandrena is applied to larger area absorption decreases significantly. To some extent, however, the estradiol is stored in the subcutaneous tissue from where it is released gradually into circulation."
https://www.medicines.org.uk/emc/medicine/1392
I know there are devotees of patches and gel (and I'm a patch gal!) but I would suggest that you would more easily tell if your levels were right for you using patches as there is less room for user variability. Blood tests may give an indication but more than one would be needed... - and would be more relaible if you are post-menopausal.
Hurdity x
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Thank you didn't know to shake the bottle or how big an area to be applied. I have been rubbing it in to dry quickly. Will give these both a try so thanks for the info. Is there any benefit to apply it to arms or legs ?
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I can't help as such except to say that I started with estrogel and just couldn't get it right! Dose kept increasing but estrogen levels were still low and I could literally feel it running out! As soon as I changed to estradot I found dose much more stable! Don't get hung up on how many pumps you're using compared to others - what matters is how much you're absorbing which can only really be determined by regular testing (or how you feel!) I had weekly testing for a few months - very pricey but now 1 year later don't have any!
Have you tried estradot? Gel doesn't suit everyone ...
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I would not apply it to upper arms - most of the transdermal HRT types (patches/gel) says to apply to lower trunk ( to be sure it is far from the breasts), but I know some women do apply it to their arms - I wouldn't personally though.
I'm sure I've said before I'm on Estradot too like Suzyq and love it!
Hurdity x
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Hi estradot was my first transdermal and worked great for 7 weeks then all symptoms returned so tried two pills and now gel. Since then I have had my ovaries shut down as they were all over the place. Wondering if it might be an idea to give the patches one more try x
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Omg think I have been applying the gel wrongly. I was rubbing it in until it was nearly dry. Now been applying it and leaving it to dry. Hormones all over the place. Not sure what dose I am getting now but burning back and tingling head. On 5 pumps at the moment don't know if this is too high now as think may be absorbing it quicker. All jittery now no idea if high or low
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Anxiety gone haywire & burning guess I've not been absorbing it as now mega high. Not sure how much to reduce doseage tonight :-\
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Omg you are having a nightmare with the estrogel!! If you feel really jittery etc it could be too much estrogen (that's how I feel with too much) so you can either stick with 5 to see if it settles in or change to maybe 4 for a day or two. As you got on with estradot ok for 7 weeks I would definitely think about changing back. It could have been just your own hormones (at the time) chipping in, but tbh it did take me a good 3 months to completely settle on it and even now I still get the odd blip when it's all a bit off (just not very often now).
For me the problem with the estrogel is uneven absorption and the tendency to keep changing dose - a bit more a bit less etc to constantly try to get the right dose! I've read stories on other websites and other ladies have the same problems taking high doses with low estrogen levels! I know you've recently had your own hormones shut down and honestly I think that is contributing to how you are feeling. It's a massive step and I just don't think you can achieve wellness or consistency in a short amount of time.
This is just my opinion, so feel free to ignore, but you seem to be having some torrid times with it all!
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Thanks asked about applying it and was told he didn't know of any problem with rubbing it in until dry. And said I had success with patches but said I had no skin conditions so should be absorbing fine. I am at a loss and I agree completely with what you say having it there makes it far too easy to try adjusting way too quick. I even admitted that to the consultant wanting him ti say back to patches
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It's not about a skin problem, some ppl just don't absorb it well! I just tell my specialist what I want - they're not very quick on the uptake! So sorry you're having a rough time xxx
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Hi Suzyq
How did you know you wasn't absorbing the gel??? I too have wonder if this is my problem.
Also - how much patch are you on ?? Im struggling at the moment especially during the day when I get so hot with sweats and lightheaded, always starts a couple of hours after 2 pumps of gel. Feel better late afternoon.
W
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I knew I wasn't absorbing it as was still having symptoms and I had regular blood tests - they were always showing low estrogen levels! I am now on estradot 75 - was prescribed 100 but was too high for me. I read somewhere that if you feel great straight away then start to get problems later, dose is probably too high - that was true for me. When to high, I get lots of anxiety and very jittery (along with sore boobs). To be honest it got easier for me to work out as I stuck with a stable dose and evaluated my symptoms so it takes time! That being said I could never get stable on the estrogel and although I felt like a bit of a failure as others got on well with it, I would now never change back! That's the thing with hrt, different things work for different people ...
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Thanks Suztq - I get my blood results on Thurs and take it from there. I know the Consultant is keen for me to come off HRT as Im 56 in Feb (5 years on HRT) and in her opinion 5 years is the limit. I think that's old school thinking :(
W
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My mum was on hrt until nearly 70! Her gp refused to prescribe it but as she spends half the year in Spain, she just bought it over the counter!! When she stopped (she just kept forgetting to take it) she had no return of symptoms!
I've just turned 50 and plan to reduce my patches gradually from the age of around 51 but if things get too bad I won't hesitate to restart. I think it really is our decision and easier for me as I have private specialist - that's our only real option here in canada!
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Hi consultant advice is go by symptoms. Reduced from 5 1/4 to 4 and tiny 1mm in syringe yep system that sensitive. Tight chest gone nit much anxiety but feeling of just can't relax. Boobs still sore and sexual urges there but not as strong. Question is how long do I wait to see if dose is still to high. Only been a week reducing x
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I would give it a month donna really. The body has to undergo all sorts of changes - not just in the bloodstream so keep that up for a while longer.
Warwick - yes - old school thinking - you absolutely do not have to stop - heavens - I'd only just started at that age! By all means see if you can reduce the dose a little - but only a little - but if after 3 months you are feeling terrible then increase again - if no medical issues to the contrary.
Hurdity x
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Thanks will start a month countdown x
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Hi
Just got back from Hospital. Results from blood test:
Estragon - 26.9
FH- 2.0
Does anyone know what this means?
Consultant not interested in symptoms just kept saying at my age should be on lowest amount :( not sure I have faith in this Consultant. Down to 3 pumps of gel
W
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That sounds extremely low oestrogen warwick if it is accurate - and I would question that, because if it is in pmol/l (which it usually is in UK) then it is a very low reading for someone in post-menopause who is not taking HRT.
I would ask for a print-out of your results - not sure what FH is? If it's FSH then that's also very low!
I'm not sure what the consultant means by the lowest amount - surely that is zero! I understand the general principle of HRT is to be on the lowest dose that controls symptoms (although this is almost always less than the "feel-good" level) but to pick an arbitrary lowest dose (whatever that is) seems bizarre.
How long is it since you reduced from 4 pumps to 3?
Hurdity x
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Hi Hurdity
Thank you for replying (was hoping you would)
What she said was the results were high for a post meno woman, she would expect this result for a women who was ovulating.........grrr
FSH - sorry ???
I have been on 3 pumps for 4 weeks now, sweats came back but seem to have settled last few days.
When I asked about other hormone results i.e prog,test she said they don't do this test as no need in post meno women. She never heard of Utrogesterol therefore I have o confidence in this Consultant. Unfortunatly she s going to write to my GP with her recommendations of which I don't agree with.
Any idea what estragon reading should be in post meno women?? as I have no idea!
Thanks again for your advice ;)
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I am really confused . Maybe I am wrong, but I thought estrogen should be high at ovulation, not low (which, at 26.9, yours seems?). I don't understand what your doc means by saying this level is high and suggests you're ovulating? Mine was 40 and doc and specialist both said this was v low. Can someone explain? X
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Low FSH levels indicate you are still ovulating, high levels mean you are approaching menopause.
https://www.centerforhumanreprod.com/infertilityedu/causes/highfsh/?gclid=CPXctZHjmsMCFWSWtAod02UAoA
Its not static though as sporadic ovulation can occur up until the final period.
Estrogen drops just before ovulation and then rises again along with progesterone.
Its difficult to judge what is going on at perimenopause with blood tests as this just shows what is happening at that particular point in time.
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That really helps. Thanks Silverlady, especially for the link. X
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Silverlady - thank you for the link.
Have you any idea what the Estragion level should be for a post meno women??
Remember I was using 4 pumps of Oestrogel at the tie of blood test which came back 26.9 so not sure what consultant expected?
Really confused ???
W
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Hi warwick
Just noticed this again so a quick response to your Q. I repeat that the reading is incorrect if it is referring to your estradiol levels.
As I said in my post - that reading (in pmol/l) is in the range for post-menopausal women. If you had been given this reading without HRT and your consultant had said that it was low - then it is likely to be correct.
The fact that you are on quite a high dose of gel ( even if you are not absorbing it correctly) and your consultant said your dose is high and is the same as someone who is ovulating - means it has to be wrong. Were you given this as a print-out?
Take a look at the reference ranges here: http://en.wikipedia.org/wiki/Estradiol - scroll down until you reach the table and graph. Post-meno range is from almost nothing (according to this) to 130 pmol/l.
Pre-ovulatory peak - the range is 400 - 1500 pmol/l.
You are post-menopausal I presume, given your age - and even if you were still fertile your levels would not be as low as this during the cycle.
I would say the reading is a mistake and is not what the consultant is referring to (if it is estradiol levels)
Hurdity x
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This may explain it warwick01
"Normal estradiol Day 3 value -- 25-75 pg/ml
In spite of the above number, generally, estradiol levels about 30 or below -- in conjunction with a high FSH level (high in this case, meaning in the post-menopausal range, i.e. 30-40 or higher) -- is considered menopausal. (Important note: If your FSH hasn't reached post-menopausal levels and your estradiol is on the low side, you are not considered POF or EM. There can be other reasons for low estradiol, including excessive exercise, low body fat, and diminished ovarian reserve.) This is because estradiol levels tend to drop over time. During the first 2 to 5 years following menopause or ovarian failure, blood levels of estradiol drop to an average range of about 25 to 35 pg/ml. Women not on HRT generally will see this number drop even more over time; after about five years, it's common for menopausal women who aren't on HRT to have estradiol levels below 25.
If your estradiol levels are lower than 50 picograms per milliliter, you may still be having a period, but also may be experiencing symptoms of low estrogen -- including hot flashes, vaginal dryness, and sleep difficulties"
Post menopause estrogen levels vary from woman to woman depending on fat levels, diet, health of ovaries, or whether a woman uses Hormones, and maybe genetic factors.