Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Lamplighter on May 26, 2021, 04:14:14 PM
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Hello everyone, I've noticed in a number of posts on here people talking about getting a reading for their oestrogen levels, and remarking whether they are too high or too low.
I've never heard of getting this done and wondered how you go about it - is it something you ask your GP to do, or does it arise out of investigations into other things?
I'd be interested to know what my levels might be, as it strikes me that that might be a much more effective way of regulating HRT than the whole hit and miss of trial and error and its attendant symptom horrors.
All info and any advice very much appreciated :)
LL xx
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Hi Lamplighter,
My experience is that doctors are often quite reluctant to do the lab tests as levels tend to fluctuate so much during perimenopause that its difficult to read much into it. Symptoms used as a guide, even though it is this painful trial and error sometimes. ::)
But it does make sense if you are on HRT and not getting the desired effect from it. Then it is useful to check what the estradiol is, to see if you are absorbing properly. Beyond that not sure how useful the tests really are. My understanding is that generally the right level is very individual, i.e. someone might feel ok with a certain level while for someone else that is too low/high. And it seems to vary even within the same person. I got my reading last year before starting HRT and was 90 pmol/l, which is very low. Despite the low reading, I was not feeling super bad -just the flushes and insomnia. Was tested again recently as my symptoms got much worse and was 160, which is still too low, however one would expect feeling better than with the 90, but for me its actually the opposite. Go figure.. ??? Probably its not only the level, but also the fluctuations that are causing the symptoms but these cannot be tracked with single blood test unfortunately.
Maybe ask your GP and see what he/she says?
Take care xx
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Thanks EllaAurora for that comprehensive (and very informative) reply. Sadly it does make sense what you say, about fluctuations and individual differences. I'll be speaking to my GP in the next couple of weeks so will ask her about it then and see what she says.
I suppose I'm just tired of all the trial and error and the fact that so many different forms of HRT can have such different effects, but you don't know until you try them :(
LL xx
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You can ask but you're unlikely to get it on the nhs as they go by symptoms not levels. If you're being treated privately they're more likely to test levels but you'll pay for it.
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Thanks Sheila99 xx
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I suppose I'm just tired of all the trial and error and the fact that so many different forms of HRT can have such different effects, but you don't know until you try them :(
LL xx
That's exactly the way I felt when I started on this journey, I naively expected testing and given the right hrt at the right dose. I really wasn't expecting the 'suck it and see' approach. I've learned from this forum just how different we all are. A regime that suits one person is a nightmare for another and there's no obvious reason why. Levels seem to be similar although they give an indication. It seems the level you feel good on can differ too.
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This is exactly how I feel too! Very frustrating having to go through the trial and error, and that it takes so long to see what works and what not. Not to even mention the fact that the same regime may first work and then stop working -for the same person! :o
The blood test helped me with one thing, though, and that was to answer the question of too much/too little oestrogen, which I also had earlier. Since I was feeling so bad, I thought maybe I am overdosing, but seeing the low blood estradiol level at least I got confidence to continue on the higher dose regime to which I'm now trying to adjust.
Keep us posted Lamplighter on how you proceed & hope you feel better soon! xx
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I have had many estradiol tests and my reading would come back sky high every time but I was and still am so ill but finally one showed a low reading thankfully and confirmed that the others were fluctuations. If you are in peri then the lead up to menopause can be a chaotic rollercoaster. I wish my private menopause doctor stopped insisting on Estrogen tests because for me it has been a waste of money, they should go on symptoms.
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I've just ordered a home test from medichecks. It was £79, but not as much as through a private consultation/clinic.
I also just would like reassurance that increasing oestrogen dose is the right thing to try, versus maybe needing something else like testosterone... If I understand it correctly, oestrogen levels need to be optimised before trying testosterone anyway so knowing where I am will help me understand where I am! I think!
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EllaAurora, Floo36 and Devon51 thanks for replying, and for the informative comments. On balance it seems like the oestrogen readings aren't terribly reliable in terms of determining how high a dose of HRT to take - on the whole I suppose it's worth knowing whether they are high or low though. You'd think that given the fluctuations, the tests could be done on an average basis rather than a one off.
Devon, I didn't know you could do home tests - how reliable are they do you think? Sounds like the NHS isn't going to cough up for a test and like you and Floo I think paying a private consultant's exorbitant fees for something that's not as useful as it should be is a bit on the nose.
As I'm well and truly postmenopausal I would hope my levels are fairly stable (read, non-existent!) though it always seems to me like every now and then they decide to drop another notch, with a consequent increase in negative symptoms.
EllaAurora I''m curious about your comment re a particular regime stopping working after a period of time. Do you know why that would happen? It makes the whole thing even more frustrating, as well as despair making - this endless search for something that's going to fix the problems so we can just get on with life :bang:
Thanks again everyone xx
LL
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You can find that you need more oestrogen over time as you produce less yourself. Usually an increase in oestrogen will solve it rather than a change in regime.
I'm intrigued to find out what happened to you EllaAurora? Great name BTW.
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I have had a fair few levels done. I think it’s because I am on a very high Oestrogen dose and they want to check it hasn’t gone too high.
I’ve also had them when I feel very low, despite being on the high dose :)
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Having bloods done in late peri is like chasing a moving target. I think they are useful if the fluctuations have stopped unfortunately mine are extreme and I’m going from symptoms. I feel normal for sometimes a few hours followed by either a panic attack or severe mood swings but most of the other symptoms of low Estrogen all of the time the worst being the complete insomnia which is torturous and no end in sight until I get enough Estrogen. You have to decide for yourself if testing is worth it, if you are post then it willtell you what your levels are at the time but it won’t tell you what level you need to be to feel well, I guess doing a test when you are well would be an option.
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Thanks Sheila99, Salad and Floo36 for replying :)
Sheila99, I'm 12 years post menopause, I'd have thought by now the oestrogen levels would have dropped as much as they're going to. It sounds like you're saying they keep on dropping if not forever, then for a much longer time than you'ld expect - would that be so? In which case it's all a much bigger nightmare than I already think it is :( :( :(
Floo36, that's good advice - testing when you're more or less symptom free (but whenever is that ::) ) to find out optimum levels makes a lot of sense. Right now I'm still all over the place symptom wise so perhaps will leave the whole issue of testing my oestrogen levels until further down the line.
Thanks everyone for your helpful input xxx
LL
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Most oestrogen is produced by the ovaries but smaller amounts are produced by the adrenal glands and fat tissue and it's this that can decline post meno.
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Shelia99, ah that explains it then. Thanks xx
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Hi again,
coming back to the question related to what happened to me. I'm still trying to figure it out myself :o, but here's how it went.
I was doing great with Oestrogel 1 pump/Utrogestan 200mg (cyclically) for the first 9 mo. I was even surprised how well it worked and without side effects. I was quite relaxed about how to apply the gel (not paying so much attention that I'd do it exactly the same way every day), or even the timing. I might occasionally miss the regular time and apply couple of hours later, without any consequences on how I felt. All in all, I could live my life without having to focus on the menopause (what a dream state, now that I think backwards :P)
Then, Dec/Jan/Feb didn't have withdrawal bleed at all (despite taking Utro as per the regime) and had super sore breasts. Interestingly at this time, felt mentally even better than usual -lots of energy to do sports and great mood, so I wasn't that worried about the missed bleeds. Then March and everything changed! :o First I got the bleed, which was heavier and more painful than I've ever had in my life. Then started heart problems, insomnia, diarrhoea, adrenaline surges, and worst of all the anxiety. Visited several doctors over the following weeks as I thought at first there was something seriously wrong with me physically. (nothing was found)
Following gynae instructions tried to up the dose to 2 pumps of Oestrogel which suddenly didn't work at all! ::) Got bad reaction 1-2 hours after applying (super jittery, anxious, heart rate going sky high, shaky etc). So after couple of attempts, went back to 1 pump and then few very bad weeks later figured that some ladies here were splitting the dose, and decided to try that. I'd previously applied 1 pump in the evening, now I started very slowly adding -first half a pump and then full pump also in the morning. That helped a bit but still kept having the jittery, anxious and shaky feelings after applying the gel. It felt like the oestrogen was absorbing too quickly, I'd have a feeling of 'rush' 1-2 hours after applying and then a feeling of the dose wearing off some 6-8 hours later. (not sure of course if this is really the reason)
After trial and error I've now figured that these reactions were coming stronger if I applied on a smaller area of skin, or on a thin skin (arms, inner thigh). For a week now applying to lower belly and being meticulous about applying exactly every 12 hours and in an exactly same way (i.e. larger area). So far so good -no jittery feelings after applying, though I still feel overall the oestrogen levels are low, but perhaps more stable. My gynae just recommended to switch to Patch but I am not yet ready for that step and another change, as at least currently I am feeling a little better than a month ago. Probably will wait couple more weeks to see what happens with this regime and then decide.
All in all, very tiring and consuming so much of that little energy that I have overall these days ::) I don't know what in the end caused the change. My own assumption is that after the heavy bleed, my own estradiol dropped to a permanently lower level and previous amount of gel was no longer enough. Why I developed these tolerance issues... have no idea ::) Maybe someone else in the forum has had similar symptoms and would know more?
So great that weekend is coming.. wishing a relaxing one to us all! EA xx
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It’s also difficult in peri to know if it is in fact the hrt doing anything or your own hormones that have risen again to give symptom relief but not fully. I have had this happen a few times over the last two years, I finally worked out when my symptoms erupted again and an increase in dose did nothing that I worked out I didn’t absorb the transdermal tried so far. I’m hoping it will be much easier post menopause to manage.
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So true Floo36. Impossible to know in the end what causes what. ???
The only thing I think I've figured out so far is that the fluctuations are the worst (whether caused by own oestrogen fluctuating or changing the HRT dose). But in peri, fluctuations are impossible to avoid, so trying my very best to at least keep the HRT dosage as stable as possible.
Hopefully postmeno will bring some relief to this.
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I'm late peri now and yes, it does get easier as your own hormones stabilise. It's normal to need more oestrogen as you head towards meno. I've had to increase twice as symptoms returned, started on 2 pumps and now on 4. EllaAurora I think you're right with your assessment. I get sore boobs with high progesterone so maybe that happened to you and if you were producing your own at the end of the utro phase it would have overridden the hrt withdrawal bleed. Your symptoms following the bleed are indicative of low oestrogen.
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Thanks Sheila99! I agree, low oestrogen seems to be the issue, so I'm now on desperate attempt to get more of it into my system. Just need to find a way how to increase without getting these anxiety reactions 1-2 hours after applying.
When you increased from 2 to 4, did you have any issues with it? How often and where do you apply the gel?
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I didn't go straight from 2 pumps to 4, there were several months, possibly a year, between the increases. I split it into night and morning but if I'm late or early with it I don't notice any difference. I did use an extra half pump for a couple of weeks before using the full pump. I put it on inner thighs but that's more convenience (far too cold for bare shoulders in my house :(). I don't have a surge like you do. I understand how desperate you are to feel well but I think slowly is the way to go, your body needs time to adjust.
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This is such a great thread! I've been curious about the sense of "shooting in the dark" if not knowing levels. Very postmenopausally, as things have stabilised relatively in terms of oestrogen supply, it would be great even to know if what's left is on what sort of range from low to non-existent! I'm sure this could fast track a lot of trial and error in this group?
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I had an oestrogen reading back in February this year through a blood test. I'm not HRT but I wanted to find out how low it was and how much lower it's going to be. It's lkkely to decline even further because my reading was 586pmol and I haven't had a period for 16 months now. I am feeling comfortable not knowing where I'm at so now snd again, I will do a blood test. Now that I'm classed as postmenopausal, It's very unlikely that my oestrogen will shoot back up to where it was prior to the menopause.
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Postmeno3 you could arrange your own. Try medichecks. I used them for thyroid though not for oestrogen but them seem to have a comprehensive offering.
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Shella99, is it the oestrogen from the fat tissues and adrenal glands that declines postmeno? I would have thought that it the oestrogen produced by the ovaries until it stops producing it. Otherwise, we'll have absolutely nothing left and therefore a level of 103 pml would not exist.