Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Salad on March 20, 2015, 11:42:50 AM
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I've just returned from my GP to get my most recent Oestrogen level result- bad news :'(
We've been anticipating a problem as my oestrogel dose has gradually been increasing in order to control my break through of symptoms. I use 4 pumps of oestrogel in morning to control all my symptoms in the day, then have been using 1-2 pumps before bed in order to get through the night.
My level has gone from 640 to 2300!
I'm now under instruction to reduce my dose but I am dreading having to experience my menopause symptoms AND try to keep working/living.
Has anyone had experience of Tachyphylaxis and know how long it'll take before I feel ok again?
Any advice really appreciated.
Sat here feeling a bit sorry for myself with a cup of tea and some emergency chocolate my husband has just given me :)
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Sorry what is tachyphylaxis.... ???
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It's a progressive decrease in response to medication, so you increase the dose to counteract the lack of response.
My GP wonders if I'm absorbing the gel too quickly, hence the super high level then as the day goes on I'm using it up and the level slumps so my symptoms show up - instead of the steady absorption I'm supposed to be doing.
She's swapping me to a patch to see if that helps at all- I guess anything is worth trying :)
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Oh dear Salad poor you - how strange - that is a very high dose! Patches deliver a very consistent dose and don't depend quite so much on the vagaries of application and absorption.
In terms of oestrogen and HRT tachyphyllaxis is explained here and generally is only a possible problem with implants:
http://www.studd.co.uk/implants.php
Too frequent implantation or too high doses of oestrogen leads to supra-physiological oestradiol levels and the recurrence of symptoms even at these high levels.(4) It is not easy to treat and it must be said that the secret is to avoid it happening by using the correct dose of hormones in the first place. The normal range of plasma oestradiol during the ovarian cycle is between 100-1500 pmol/l but plasma oestradiol levels greatly exceeding these values can be found in patients with tachyphylaxis.
The symptoms that these women suffer are real, not imaginary although they are not always typical menopausal symptoms.(5) In fact many of these women have a history of psychological disorders.(6) Because of this potential problem, the implants should be used with caution in women with a known history of chronic anxiety or stress disorders. The recurrence of apparently oestrogen deficiency symptoms at these levels are no doubt due to the change of oestradiol levels from "very high" to "high" and they become accustomed to a higher threshold. These high levels may be unnecessary and avoidable but sometimes women with convincing oestrogen responsive depression need even higher oestradiol levels but there is little or no evidence that they are harmful.
The above relates to implants but the same principles apply.
I hope you manage to sort it out and find the right dose Salad!
Hurdity x
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Patches worked better with me than gel.
Hope you can get it sorted Salad!
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Hi Salad - A colleague of mine at work who suffered with similar problems has found relief by adding the SRRI drug Citalopram alongside a lower dose of HRT. Many women seem to need both to control their symptoms.
I hope you get sorted. DG x
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Thank you for all your replies and the information Hurdity :)
It's a nightmare but guess I'll sort it eventually - things could be worse!
I'm using the gel for the next week as I'm super hectic at work and don't want to try the patch until I can cope with any increase in symptoms.
Ive been applying gel to my arms so I'm changing to my legs where I definitely have plenty of subcutaneous fat and maybe it will help me absorb more slowly.
Thanks again x
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Just noticed this having.bloods done from a gel arm will give faulty results im amazed your gp didnt know this. Ask to be retedted and.only apply the day before.not.on.the day of.the.blood.test
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Thank you for your advice Lancashirelass, that isn't something I'd thought of - (only just seen it as I've not been here for a while :) )
I made the swap to patches and once I'd worked out which one suited me best - I'm happy to say, HRT is working really well and I'm feeling good :D
Keeping my fingers crossed that it continues!
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Patches worked much better for me.
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I have been on x4 pumps Estrogel for 8 months, suddenly, hot flashes after feeling great and no flushes since HRT patches/gel 4 yrs ago. Blood results went from 380, to 1,400 to 2,300!!!! all over 3 months, and now I am in despair-nothing is working, swapped to 100 Evorel even worse flushes, and x3 estrogel, OMG!!!! NO sleep, flushing all night. Now what? back to x4 gel, still sweating but not as horrific as x3. Tiny amounts of T gel as GP thought it may be converting to E, and Norothisterone for 10 days as Utrogestan did nothing to stop spotting. Also changed to x2 AM and x2 PM of O gel, it hasn't made much difference. Look 100 today, red sore eyes from the Norothisterone, and generally in complete despair. So much so that I took some DHEA to perk myself up. Any ideas?
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Hi, are you in peri menopause? If you are it seems that your own hormones are fluctuations which can cause spikes in Estrogen, does with me at the moment.
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Hi - mayB ask for a patch which gives a more level dose 24/7?
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Hi - mayB ask for a patch which gives a more level dose 24/7?
This is what I was going to suggest too :)
I went from 4-6 pumps of gel to 175 mcg Estradot patches with much better results.
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Thanks everybody, I did try Everol 100 patch, they were always fine before, but now, argh!! flushes all night long, it's like nothing is working at all. Back to x4 gel. I am 56 today, lol, and way past peri, so I am thinking something happened with conversion of T or P to E..Maybe. I did stop T, as GP said it was probably that, but didn't feel any different, just felt all my muscles and energy disappear. It's really strange.. Boobs bigger, plenty of bleeding, so something is happening, but the flushes/poor sleep is ghastly!! I have a job/college course/2 kids under 13, and I'm single- I just cannot cope with this HRT hell. And dropping gel dose to x3 was really horrendous. I am taking DIM.. Can't say I notice any difference. every avenue now seems closed...
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Have you taken Dim recently or for a longer periode of time? Dim can flush the more potent estrogens out of your system. It is recommended for so called estrogen dominance. I think you should try to stop Dim first and see how you go. When I tried Dim it gave me a horrendous headache for 4 days and I only took one pill. Tried it again to be sure and the same thing happened.
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Salad..That is a high patch dose, but love that idea..if I can get GP to agree, so 1x100 and 1x75 at same time? How long did it take for your level to drop to a "normal" level? I am so interested in your story, it seems to mirror mine!
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Salad..That is a high patch dose, but love that idea..if I can get GP to agree, so 1x100 and 1x75 at same time? How long did it take for your level to drop to a "normal" level? I am so interested in your story, it seems to mirror mine!
The level dropped quickly, that was half my problem. Changing to patches gave me a more consistent dose.
I was prescribed 2 x 100mcg patches by the Menopause Specialist and told to cut the patch if I wanted to adjust the dose.
I cut off a quarter, so 175 mcg in total.
I did increase to 200mcg last year and this year I would need to go higher.
I have just spoken with a Menopause qualified GP and I am now trialling Lenzetto spray - I’m due a review in a couple of weeks.
The dose should be 3 sprays, but I need 4.
It’s a bit of a challenge for some of us to find a good dose :D
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Lenzetto is quite weak, i got in touch with the manufacturer about how much a dose is expected to deliver and its not much so a lot is needed to achieve a higher dose.
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Lenzetto is quite weak, i got in touch with the manufacturer about how much a dose is expected to deliver and its not much so a lot is needed to achieve a higher dose.
That’s interesting- thank you. I can certainly feel it wear off ::)
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my meno nurse was horrified by my high level and said stop all HRT. No way am I doing that! But levels over 2,000 are so scary. GP said that I'm absorbing but rebound is happening so all symptoms return. Scared now, and no idea what to do. I tried DIM the last 3 weeks to try to force levels down, not seem much difference, but boobs have reduced-just what I do not need!!! flushes and no sleep remain. the 100 Evorel was horrendous, I had to stop that and go back to gel.Flushed all night long, the worst!! It used to be fine.
Salad..I am very interested in your 1st post-what happened? did your levels reduce, did you just have to go higher and higher doses? All I know is that I feel awful but with off scale blood estrogen
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My estrodiol was tested as 3126 pmol/L last July. Once I saw that, I stopped immediately because I was sure I was going to get a chastising phone call. To my surprise, I actually felt okay off it. I had headaches often but manageable. I was off estrogel entirely for about 6 weeks, then I restarted with half a pump a day. Worked up to a pump (or 2? can’t recall for sure) and in late October my E2 was down to a much more reasonable 316 pmol/L. Currently I feel much better on one pump than I did with 4.
I understand your hesitation to change things but it might not be as bad as you think.
Someone said here (read it last year) that at a certain point, your body shuts off receptors to estrogen when flooded like that (or something to that effect). Like once you get to a point where you’re taking much more than you need, nothing is getting in. A high blood level is present but the body cannot use it. So you may be served better with a lower dosage, one that doesn’t close the windows and the doors as it were. Another way of looking at it is a bell curve—-there’s a patch in the middle where you get the best results but go too far to either end and the effect decreases.
Sorry I have zero references for this.
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Thanks for your tips and stories. I just had my worst night yet, soaked in sweat. I hoped that changing to split dose x2 x x2 of gel would do the trick-sadly not. Terrified to stop HRT, absolutely terrified. Stop and wait a few weeks or.. what? lower does, raise dose, I have no idea. Lower I suppose, but last year, on x3 gel, my blood test was 350, not very high, low even, when I do best on 800. SOOOOO what the hell happened?? Nothing makes any sense. I am very depressed now
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Hi Bev,
I have learnt a lot recently and like you panicked when my bloods show between 1100 and 5000pmol over a 5 day period. My levels are not like that they are spikes in estrogen because of fluctuations. I then did another test on one of my worst days and this was 457pmol which is low estrogen for me which is why I have all my symptoms back and more. It may not be what is happening to you though but may be worth a thought.
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Floo, How did you remedy this situation? Are you ok now, what stopped the fluctuations? What caused them?
My GP is useless, and the meno clinic are equally useless. I really don't know what to do today- have a few different patches from last yr/lockdown, Estradot,Estraderm, various strengths. Not sure where to go at all, stop/cut down/raise!!!
The gel is useless at the moment, and maybe the DIM has dropped my levels..Will stop that tomorrow.
I was liking the Testim, Doc said stop that, it may be converting, not happy about that, so now I feel like I will shrivel overnight. The flushes at night are the worst, I was SOAKED last night, this cannot be right. I have such a stressful job and young kids.
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No I'm struggling but at least I now know for certain that I need more estrogen and my blood tests finally proved it. I'm waiting for a call with the menopause clinic to discuss how I'm going to get enough estrogen, I don't absorb too well on gels or the patch I tried. Im on Lenzetto but it's too weak but great and easy to use and just started adding 1mg Sandrena in the hope it starts to make a difference however small.